Medical Certificate Request

Please complete this form if you have recently had a consultation with your GP and forgot to request a medical certificate, or if you have lost your certificate/were advised one would be sent but did not receive it.

Medical certificates can only be issued within 48 hours of your consultation. If it has been more than 48 hours, a $35 administration fee may apply, or you may be asked to book another appointment.

Please allow up to 3 business days for our team to respond to your request.

PATIENT DETAILS

Date of Submission

First Name *

Last Name *

Date of Birth *

Contact Phone Number *

Email Verification *

Send code

MEDICAL CERTIFICATE DETAILS

What does your enquiry relate to? *

Attention to (GP name) *

Date you require your certificate FROM *

Date you require your certificate TO *

Please provide us with details of your request *

Browse if you would like to upload a document relevant to your enquiry

Browse

Signature *

Clear

Date *