Medical Certificates from medicalcert.co.uk

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

2

Date of Birth* This field is required.

Date

3

Sex* This field is required.

Female

Male

Prefer not to say

4

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

5

Phone* This field is required.

6

Main reason for the cancellation* This field is required.

7

Start date of your symptoms* This field is required.

Date

8

Condition status* This field is required.

Ongoing

Partially Recovered

Recovered

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Please describe all your symptoms and timeline in detail. Please provide as much information and detail as possible.* 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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Planned Travel Date (Outbound)* This field is required.

Date

11

Planned Travel Date (Return)

Date

12

Airline / Holiday Provider

13

Are you pregnant or breastfeeding?* This field is required.

Yes

No

14

Please provide details regarding your pregnancy

15

Have you sought medical care from your GP or local A&E for your medical issue before?* This field is required.

Yes, from my GP

Yes, I visited A&E

No, never consulted a doctor for this before

16

What treatment was administered in A&E or by your GP?* This field is required.

17

Please upload photos of your A&E discharge summary, if available

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

18

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

19

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

20

Medical Evidence

Please attach:

Photos of your condition or any medical evidence (eg. clinical letters, test results, prescriptions, screenshots of your NHS app etc.)
A photo of your travel ID or Passport
A selfie to confirm your identity

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.

21

Please upload any photos or medical evidence* This field is required.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

22

Please attach a photo of your travel ID or Passport as proof of identification.* This field is required.Name on the ID should match the name on the certificate.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

23

Take a SelfiePlease take a photo of yourself for identity verification purposes. If your current device does not have a camera, you can click below to save this form and return to it on another device later.

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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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Travel Cancellation

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Payment* This field is required.Please do not refresh or close the page after clicking submit.

My Bag

1

Travel Cancellation consultationIf we cannot issue your certificate for any reason you will receive a full refund.
£39.00Edit
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Add-on a Custom Cancellation FormIf your airline requires a specific custom form completed, please select this add-on and send your form to certificates@medicalcert.co.uk
£10.00Edit
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First Name

Last Name