Custom 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

Why you need the certificate

Tell us about the certificate you need and the condition it’s for.

What is the main reason for your medical letter? *

Please provide as much detail as possible. If our doctors do not have enough information, it may delay your certificate as they will need to contact you to clarify.

0 / 20 characters minimum

Please provide at least 20 characters

Please describe your condition, your symptoms and timeline in detail *

20 words minimum. Please provide as much information and detail as possible.

0 / 20 words minimum

Please provide at least 20 words

Whom will this letter or certificate be provided to? *

Please tell us who will receive the letter

Are you registered with an NHS GP?

Medical background

A couple of clinical questions to help our doctors prepare your certificate.

Are you pregnant or breastfeeding? *

Yes No

Please select an option

Please provide details regarding your pregnancy *

Please provide pregnancy details

Have you sought medical care for your issue before? *

Yes, from my GP or a specialist Yes, I visited A&E No, never consulted a doctor for this before

Please select an option

What treatment was administered? *

Please describe the treatment

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 list any allergies you have *

If none, please write none.

Please list your allergies or write “none”

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

If none, please write None.

Supporting documents

Upload documents now, or email them to us after submitting.

Send to certificates@medicalcert.co.uk with your submission reference.

or upload now

Please upload medical evidence

📄

Tap to upload or drag & drop

JPG, PNG, PDF — max 10MB

Please attach a photo of your ID as proof of identification

🪪

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JPG, PNG, PDF — max 10MB

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

🏥

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JPG, PNG, PDF — max 10MB

If you require a specific custom form completed, please upload this here

Optional — only needed if a specific form must be completed and signed.

📋

Tap to upload or drag & drop

JPG, PNG, PDF — max 10MB

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 request that the clinical review begins immediately and I acknowledge that I will lose my right to cancel once the service has been fully performed.

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 represents the doctor’s considered opinion based on the information available. It does not guarantee fitness or any specific outcome. Nothing in this disclaimer excludes or limits liability that cannot lawfully be excluded.

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.

Custom Medical Certificate £87

📧 Certificate delivered to

Please tick the consent box on the review step before paying.

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Custom Medical Certificate

Your details

Contact details

Why you need the certificate

Medical background

Medical history

Supporting documents

Review your details

Payment

Consultation Submitted