Your Virtual Health Consultation

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Please click the arrow below to get started. We only ask for payment if approved.

Important reminders…

Notes are not meant for use with FMLA, worker's compensation, disability claims, or legal matters.

You must be 18 years of age or older to request a note. For a child or minor, a parent or guardian can request it.

Notes are not meant for serious illness. If you are experiencing a possible medical emergency, please seek medical attention in-person instead.
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Please select the State you are physically located in.* This field is required.Your doctor will be licensed in your state.
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
We offer our services in most states across the country.
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Our apologies, but we are currently unable to provide services in your State.If you would like to leave us your email, we can contact as soon as it becomes available.
example@example.com
Confirm Email
4
Please let us know who the doctor’s note is for.* This field is required.Parents or guardians are able to request a note on behalf of a child or minor. If you are under the age of 18 please have your parent or guardian complete the form.
MyselfSomeone else
5
Please let us know YOUR first and last name.* This field is required.This is how your name will appear on the note.
First Name
Last Name
6
Please provide YOUR date of birth.* This field is required.Please type in the numbers with 2 digits for the month, 2 digits for the day, and 4 digits for the year.
Date of Birth
Month
Day
Year
7
Please provide the first & last name of the person you are requesting a note for.* This field is required.This will be the name that appears on the note.
First Name
Last Name
8
Please provide the date of birth of the person you are requesting a note for.* This field is required.
Date of Birth
Month
Day
Year
9
Please let us know YOUR first and last name.* This field is required.
First Name
Last Name
10
Please provide YOUR date of birth* This field is required.
Date of Birth
Month
Day
Year
11
Please tell us what you need a doctor's note for.* This field is required.
Work
School
Both work and school
Other
12
Please select the date of the first day off needed. * This field is required.
First Day Off
Month
Day
Year
13
Please select the date of the last day off needed.* This field is required.
Last Day Off
Month
Day
Year
14
Office Policies* This field is required.The remaining questions ask about your condition and contain personal health information. We respect your privacy and keep your information secure. Please review and accept our Privacy Policy and Terms of Service.
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What is the reason for your doctor's note?* This field is required.
I am feeling sick.
I had an accident or injury.
I have a mental health issue.
I am taking care of someone.
I have a doctor's appointment.
Other
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What symptoms are you experiencing?* This field is required.Please check all that apply.
Fever / chills
Headache / migraine
Watery / red / itchy eyes
Earache
Nasal congestion / runny nose / sneezing
Sore throat
Cough / chest congestion
Abdominal cramps / pain
Nausea / vomiting
Diarrhea / constipation
Menstrual cramps
Body / muscle aches
Fatigue / decreased energy
Skin rash / burn
Allergies
Diagnosed with /exposed to the Flu / COVID.
Other
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What type of injury did you experience?* This field is required.Please check all that apply.
Fall
Head injury / concussion
Fracture (broken bone)
Dislocation
Sprain / strain
Laceration (cut) / scrapes / minor bleeding
Minor burn
Swelling / bruising
Other
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What symptoms are you experiencing?* This field is required.Please check all that apply.
Anxiety
Stress
Trouble sleeping
Irritability
Sadness
Other
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Please provide any additional information that you think may be helpful.If you are requesting a date more than 1 week ago in the past, please let us know a brief reason as to the delay in seeking a doctor's note. (This is optional)
Huge
Large
Normal
Small
Ok
Ok
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Please provide an email address for the note to be sent to.* This field is required.
example@example.com
Confirm Email
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Mobile Phone Number (Optional)This is just in case our office needs to get in touch with you regarding your note. We will not use it for marketing purposes.
Area Code
Phone Number
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Congratulations!

You have been approved for your doctor's note.

One of our doctor's will review your information and certify the note. It will be sent to the email address you provided.

Our office will verify your note with your employer or school if needed.

100% money back guarantee if your note is not accepted.

Click "next" to check out and your note will be on it's way in minutes.
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