ESA Medical Certificates from medicalcert.co.uk

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Are you completing this form for yourself or on behalf of someone else?Eg. If you are a parent or a guarding.

MyselfSomeone Else

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Your Name* This field is required.

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Full Name (as it should appear on the certificate)* This field is required.

First Name

Last Name

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Date of Birth* This field is required.Please enter the date of birth of the person named on the certificate

Date

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Sex

Female

Male

Prefer not to say

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Email* This field is required.where the certificate will be delivered

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Phone* This field is required.

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What type of pet do you have?* This field is required.

Dog

Cat

Other

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What is your pet's name?* This field is required.As you would like it to appear on the certificate

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Please upload a clear picture of your petThis will be used on the digital photo-card if ordered

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Do you need to add a second pet to your certificate?Up to 2 pets can be named per certificate

YESNO

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What is your second pet's name?* This field is required.As you would like it to appear on the certificate

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What type of pet do you have?* This field is required.

Dog

Cat

Other

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Please upload a clear picture of second your petThis will be used on the digital photo-card if ordered

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Which condition(s) do you require a support animal for?* This field is required.Please select all that apply

Anxiety

Depression

Post Traumatic Stress Disorder (PTSD)

Autism Spectrum Disorders (ASD)

Personality Disorders

Schizophrenia

Phobia

Learning Disability

Other

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Please describe your disability or symptoms, as well as how your animal supports you.* This field is required.More detail will help our doctors issue your letter quickly. Insufficient detail may delay your letter, as our doctors may have to contact you for further clarification before issuing a letter.

20 words minimum.

0/0

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Do you have any other underlying health issues or past medical history?* This field is required.

YESNO

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Do you take any regular medication?* This field is required.Including both prescribed and over-the-counter medication

YESNO

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Please list any underlying health issues or past medical history:

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Medical Evidence

In order to issue your certificate, in the next pages you will be asked to provide:

Medical Documentation of your condition: This can be a copy of your GP's "summary care record" which is available from your GP practice on request or any other medical documentation of your disability/condition.
A short video recorded on your mobile phone of you describing how your animal supports you
Your ID: This can be your drivers license, Passport, or any other photo ID

Note: If you do not have your documents to hand, you can click the save icon below to save and return to this form later.

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Please upload medical documentation of your disability/condition.* This field is required.This can be a copy of your GP's "summary care record", screenshots from your NHS app, or any other medical documentation that confirms your disability or condition.

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Select files to upload

Max. file size: 15.5MB

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Please list any regular medication you take, whether prescribed or over-the-counter:

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Please attach a short video of you describing how your disability affects you and how your animal supports you

Drag and drop files here

Select files to upload

Max. file size: 97.7MB

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Please attach a form of ID as proof of identification.* This field is required.Accepted forms of ID include: photo of your driver's license, passport, work badge, residence permit, or military ID card.

Drag and drop files here

Select files to upload

Max. file size: 20.4MB

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Terms* This field is required.

I agree that upon submitting my medical consultation, I acknowledge the Terms and Privacy Policy and consent to the following: I am NOT seriously unwell with any of the following symptoms: chest pain, shortness of breath, unrelenting severe headache, worsening severe abdominal pain, loss of vision, thoughts of suicide, confusion, ongoing bleeding, unable to swallow fluids or saliva, loss of limb sensation or control, facial numbness or weakness, slurred speech. I understand the questions in the questionnaire and answered them honestly. The requested letter is solely for the individual with the provided name and details. Medical Cert is not a replacement for a doctor's visit. I confirm I do not think I need to see a medical professional in person. Medical Cert is not my primary doctor or GP, and the doctor issuing my certificate may be unable to access my NHS or regular GP medical records. Medical Cert facilitates access to private medical letters and does not issue Med3 notes, which are obtainable through your NHS GP for UK government benefits. Medical Cert is unable to process refunds once a medical letter has been written and sent to you. If my symptoms persist or I have not fully recovered, I agree to consult with my regular doctor or GP for further medical advice. I consent to having this website store my submitted information so they can respond to my inquiry.

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ESA

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My Products

My Bag

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ESA CertificateReceive your certificate within 2 working-days. Up to 2 pets per certificate.
£45.00Edit
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Add Digital Photo-Card (recommended)A digital photo-card confirms your ESA on-the-go on your phone for convenience. If you have multiple pets, please select the correct number of photo cards you require.
£10.00Edit
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First Name

Last Name