Adjustment to Work Duties Medical Certificate

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Your details

We need your name exactly as it should appear on the certificate.

First name *

Please enter your first name

Last name *

Enter your name exactly as it should appear on the certificate.

Please enter your last name

Date of birth *

Please enter your date of birth

Sex *

Please select an option

Contact details

We’ll send your certificate to this email address.

Email address *

Where the certificate will be delivered.

Please enter a valid email address

Phone number *

Please enter a valid phone number

Medical reason for your adjustment

Tell us the medical reason you need work adjustments.

What is the medical reason for your adjustment? *

Please tell us the medical reason

When did your symptoms start?

Please enter the start date of your symptoms or condition.

Start date of your symptoms / condition *

Please enter the start date of your symptoms

How long is your condition expected to last?

This helps our doctors assess the appropriate duration for your adjustment.

Condition duration *

Indefinitely / Long-term Acute / Short-term

Please select the duration of your condition

Describe your symptoms and timeline

Help our doctors understand how this affects your daily activities.

Please describe all your symptoms and timeline *

10 words minimum. The more detail you provide, the faster our doctors can review your case.

0 / 10 words minimum

Please provide at least 10 words

Role acknowledgement

Please confirm the following before we can issue your adjustment letter.

Safety-critical roles

We are unable to issue work-duty adjustment letters for safety-critical roles that require specific fitness clearance. Please read the acknowledgement below carefully.

I acknowledge that I do not hold any of the following roles: driving roles, working at heights, scaffolding, heavy machinery operation, or any role requiring specific physical fitness clearance. *

You must acknowledge this statement to continue

Supporting documentation

Do you have any other medical documentation to support your case?

Do you have any other medical documentation? *

Please select an option

Please upload any other supporting documents

e.g. hospital letters, physio notes, occupational-health reports, prior fit notes.

📎

Tap to upload or drag & drop

JPG, PNG, PDF — max 10MB

Your workplace

Tell us about your employer and what your role involves.

Your workplace / company name / institution *

Please enter your workplace

Please describe your daily work activities

Optional. Helps our doctors recommend specific adjustments.

Adjustments required

What work adjustments do you need? Be as specific as possible.

What work adjustments do you require? *

Please describe the adjustments you require

Adjustments duration (optional)

If you have a date in mind when you’d like your adjustments to end, you can add it here.

When would you like work adjustments until?

Optional. Must be a future date. Leave blank if ongoing.

Please enter a future date, or leave blank

Medical care

Have you sought any medical care for this condition?

Have you sought medical care? *

Attended A&E Visited GP Have never sought medical care

Please select an option

Treatment administered

Briefly describe what treatment was given.

What treatment was administered? *

Please describe the treatment administered

Medical history

Any relevant background health information for our doctors.

Please list any underlying health issues or past medical history *

If none, please write None.

Please provide your past medical history (or write None)

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

If none, please write None.

Please provide your medication list (or write None)

Supporting documents

Please upload the documents below so our doctors can begin your case.

What to upload

In order to issue your certificate, please provide:

A short video or photos supporting your condition (optional but helpful)
A photo of your ID or passport

If you do not have your documents to hand, you can email them to certificates@medicalcert.co.uk quoting your consultation reference number.

A&E discharge summary (optional)

If you attended A&E, please upload a photo/PDF of your discharge summary.

Optional — helpful but not required.

🏥

Tap to upload or drag & drop

JPG, PNG, PDF — max 10MB

Please attach a short video or photos

A short video or photos showing how your condition affects you, or copies of medical communication, prescriptions, test results, screenshots from your NHS app.

🎥

Tap to upload or drag & drop

JPG, PNG, PDF, MP4 — max 10MB

Please attach a photo of your ID as proof of identification

Accepted forms of ID include: photo of your driver’s license, passport, work badge, residence permit, or military ID card.

We respect your data privacy and all personal information is processed confidentially and never shared.

🪪

Tap to upload or drag & drop

JPG, PNG, PDF — max 10MB

I will send the files via email to certificates@medicalcert.co.uk instead of uploading now. (Please note, our doctors will start on your case once we have received your documents.)

Review your details

Please check everything is correct before proceeding to payment.

I confirm that the information I have provided is accurate and complete to the best of my knowledge.

I consent to Medical Cert storing and processing the information I have submitted, including health information, in order to provide this service.

I understand that Medical Cert is unable to process refunds once a medical letter has been written and sent to me.

I agree to the Terms and Conditions (https://medicalcert.co.uk/terms-and-conditions/) and Privacy Policy (https://medicalcert.co.uk/privacy-policy/).

Disclaimer
Any medical certificate is void if information is later discovered to have been falsely disclosed or deliberately withheld. The certificate does not guarantee any specific outcome but represents the considered opinion of the doctor based on the information available at the time. I absolve Medical Cert UK, Nobel Medical LLC, and their doctors of liability for any adverse events.

I have read and agree to the Terms and the Disclaimer above. *

You must agree to the Terms and the Disclaimer to continue

Payment

Secure checkout · your certificate will be delivered latest by 9AM next-day.

Adjustment to Work Duties Medical Certificate £47

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Adjustment to Work Duties Medical Certificate

Your details

Contact details

Medical reason for your adjustment

When did your symptoms start?

How long is your condition expected to last?

Describe your symptoms and timeline

Role acknowledgement

Supporting documentation

Your workplace

Adjustments required

Adjustments duration (optional)

Medical care

Treatment administered

Medical history

Supporting documents

Review your details

Payment

Consultation Submitted