Medical Certificates from medicalcert.co.uk

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

Date of Birth* This field is required.

Date

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

Phone* This field is required.

Estimated Due Date* This field is required.

Date

Pregnancy Type* This field is required.

Single Pregnancy

Multiple Pregnancy

Have you experienced any complications or adverse events during your current pregnancy?* This field is required.

YESNO

Please specify the complications or adverse events experienced:* This field is required.

Do you have a history of any of the following medical conditions?* This field is required.

Anaemia / Low blood cell count

Sickle cell disease or trait

History of blood clots

Poorly controlled diabetes or high blood sugar

Complications during previous pregnancies (eg pre-eclampsia, vaginal bleeding etc.)

Placental abnormalities (eg. low-lying placenta)

History of early onset of labour (before 37 weeks)

Miscarriage(s) after 18 weeks gestation

None of the above

Other

Do you suffer from anaemia / low blood cell count?* This field is required.

YESNO

Do you suffer from Sickle cell disease or trait?* This field is required.

YESNO

Have you ever suffered from a blood clot?* This field is required.Including leg clots, strokes, TIA, heart attack, lung clots

YESNO

Do you or have you suffered from poorly controlled diabetes or high blood sugar?* This field is required.Including pre-diabetes

YESNO

Have you suffered from any complications during previous pregnancies? (Eg pre-eclampsia, vaginal bleeding etc.)* This field is required.

YESNO

Do you or have you experienced any placental abnormalities? (eg. low-lying placenta)* This field is required.

YESNO

Do you have a history of early onset of labour? (before 37 weeks)* This field is required.

YESNO

Have you ever suffered a miscarriage after 18 weeks gestation?* This field is required.

YESNO

Do you have any other medical condition or concern?* This field is required.

YESNO

Please provide further information* This field is required.

What was your latest antenatal clinic blood pressure reading?* This field is required.

Low (below 90/60mm Hg)

Normal (between 90/60 and 140/90)

High (over 140/90)

When was your most recent blood pressure reading taken?* This field is required.

Within 30 days

1-3 months ago

3-7 months ago

Over 7 months ago

My BMI was * at the start of my pregnancy.

When did you last see the Midwife/Obstetrician for review?

Date

Planned Travel Date (Outbound)* This field is required.

Date

Gestation at outbound (in weeks)* This field is required.We are only able to certify you as fit-to-fly if you are less than 36 weeks’ gestation (singleton pregnancy) or less than 32 weeks’ gestation (multiple pregnancy) on the date of your flight.

My flight is * hours long.

Planned Travel Date (Return)

Date

Gestation at return (in weeks)* This field is required.We are only able to certify you as fit-to-fly if you are less than 36 weeks’ gestation (singleton pregnancy) or less than 32 weeks’ gestation (multiple pregnancy) on the date of your flight.

Airline / Holiday Provider

Please confirm that your midwife or obstetrician has not advise against flying* This field is required.

I have been medically advised that I may fly during this pregnancy

I have been medically advised NOT to fly during this pregnancy

Please list any underlying health issues or past medical history:If none, leave empty

Please list any regular medication you take, whether prescribed or over-the-counter:If none, leave empty

Does your airline require a specific / custom form completed?You will be given an opportunity to upload this later if yes, and we will issue this in addition to our standard fit to fly certificate for a £10 add-on fee.

YESNO

Please upload the specific form required by your airline.Alternatively, you can email this to certificates@medicalcert.co.uk. Please quote your full name.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Medical Evidence

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

A selfie (photo of yourself) for ID verification
Copy of your Antenatal / Maternity notes
A photo of your ID or Passport

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.

Please attach a photo of your travel ID / Passport as proof of identification.* This field is required.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

If you do not have this to hand, you can click on the save icon to save this form for later.

Take A Selfie* This field is required.Please take a clear photo of your face for ID verification

A copy/pictures of your antenatal clinical notes* This field is required.All patients in the UK are provided with access to their maternity notes, which are often handwritten – or patients may have access to an app that contains the same information. Please attach a copy of all pages.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

If you do not have this to hand, you can click on the save icon to save this form for later.

Terms* This field is required.Upon submitting your medical consultation, you acknowledge our Terms and Privacy Policy and consent to the following: - You are 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. - You 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. You confirm you do not think you need to see a medical professional. - Medical Cert is not your primary doctor or GP, and the doctor issuing your certificate may be unable to access your 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 your symptoms persist or you have not fully recovered, you agree to consult with your 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.

I agree

Pregnancy Fit-to-Fly

Payment* This field is required.

My Bag

Pregnancy Travel ConsultationIf we are unable to issue your certificate for any reason you will receive a refund.
£49.00Edit
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Add-on formIf your airline requires a specific custom form, please pay for this here.
£10.00Edit
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First Name

Last Name