Doctor Note Appointment and Information Form 🏥📝

Please fill out your details and appointment information to receive your doctor note promptly. For refund, we deduct $20 charges because of administration charges and payment gateway charges. Important: The date range must not exceed 7 days. Please mention the dates clearly, for example: January 1 to January 3, 2026.
Full Name

First NameLast Name
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

CityState / ProvincePostal / Zip Code
Date of Birth

MonthDayYear
Date
Reason for Doctor Note
Important: The date range must not exceed 7 days. Please mention the dates clearly, for example: January 1 to January 3, 2026.
Doctor note start date

MonthDayYear
Date
Doctor note end date

MonthDayYear
Date
Important Information
Doctor’s notes will be issued within 3 hours after your appointment. Please ensure all information provided is accurate for timely processing. Working hours: 9AM to 5PM.

Doctor Note Service

Request and receive your official doctor note after your appointment.

$45.00 CAD

Total