DocCert Form

Medical Letter Questionnaire

Before releasing your medical letter, our group of practitioners will review the evidence you submit. Only upon approval, shall you receive the medical letter via email including a unique reference number, which can be used to confirm its authenticity

I am in need of a Medical Letter regarding: Medical Certificate

Your Details

Full Name *

First Name

Last Name

Email *

Create Account?

Mobile Number *

Note: Your GP may reach out to confirm certain details.

Date of birth *

Medical Questions

Describe in detail what dates you need for the medical certificate and what symptoms you are experiencing. *

Medical Certificate Dates

Date From

Date To

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Priority options: *

Medical Certificate

This will be reviewed and typically sent to you on the same day

$40.00

Confirm your details

Please double check your details below. These will appear on the medical letter, if suitable, and can't be edited after submission.

Name:

Date of birth:

Email:

Mobile:

Letter type:

Medical Certificate

Terms

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, unable to swallow fluids or saliva, weakness or numbness down one side, 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.
Doc Cert is not a replacement for a doctor's visit, nor is Doc Cert your primary doctor or GP. Your healthcare practitioner may be unable to access your medical records.
Doc Cert cannot complete additional forms requested by your workplace, educational institution, or any other interested party.
If your symptoms persist or you have not fully recovered, you agree to consult with your regular doctor or GP for further medical advice.

Do you agree to the above Terms? *

Agree

Coupon Code

Subtotal	$0
Discount	$0.00
Total	$0.00

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