Sick Note Medical Certificate

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Your Details

Your name will appear exactly as entered on your certificate.

First Name *

First name is required

Last Name *

Last name is required

Date of Birth *

Valid date of birth required

Phone Number *

Valid phone number required

Sex *

Please select your sex

Are you pregnant or breastfeeding?

Yes No

Please provide details regarding your pregnancy

Email Address *

If you don’t receive your certificate within the expected timeframe, please check your spam folder.

Please enter a valid email address

Because you’ve mentioned anxiety or depression, we have a couple of brief wellbeing questions. These help our doctor provide the most appropriate support. Your answers are completely confidential.

In the past month, have you experienced any thoughts of ending your life? * There’s no wrong answer — we ask this so your doctor can ensure you have the right care.

Please answer this question

Have you ever acted on thoughts of suicide in the past? *

Please answer this question

One More Question

We want to make sure you have the right support right now.

Are you having thoughts of ending your life right now? *

Please answer this question

⚠ Please access urgent help Please seek mental health support immediately. If you are in immediate danger, call 999. You may also access one of the 24-hour support services below. Your safety is what matters most.

Emergency services

Call 999 if you are in immediate danger or need urgent medical help.

Samaritans — for everyone

Call 116 123 (24hr) · Email jo@samaritans.org

SHOUT — 24hr text support

Text SHOUT to 85258

CALM (Campaign Against Living Miserably)

Call 0800 58 58 58 (5pm–midnight) · Webchat

Papyrus — Young People

Call 0800 068 41 41 · Text 07860 039967

NHS 111

Call 111 anytime — they will help you find immediate support.

I confirm I have noted the support services above and agree to contact one today

Please confirm you have noted the support services

Your Condition

Your information is reviewed only by your assigned GMC-registered doctor (GMC: 7495073) and kept strictly confidential. We never share your data with third parties.

When did your symptoms start? * Enter the date your symptoms began

Please enter the symptom start date

Current condition status *

Ongoing — still experiencing symptoms Partially Recovered — improving Recovered — fully better

Please select your condition status

Have you received a certificate from us for the same condition before? *

Please answer this question

Update Since Last Visit

Since you’ve had a certificate from us before, please let us know if anything has changed.

Have any treatments or investigations taken place since your last submission? * Please provide an update on your condition if anything has changed.

Please describe any changes since your last submission

Your Symptoms

Include when symptoms started, how they’ve progressed, and how they affect your ability to work.

Describe your symptoms and timeline *

Add as much detail as you can — our doctors need enough to assess your case

Please describe your symptoms (minimum 10 words)

Have you sought medical care from your GP or local A&E? *

Yes — I saw my GP Yes — I visited A&E No — I haven’t seen a doctor for this

Please answer this question

What treatment was administered? *

Please describe the treatment received

Upload your A&E discharge summary (optional)

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Your Work & Certificate Dates

Tell us about your work and the dates you need covered.

Workplace / Company / Institution *

Workplace name is required

Describe your daily work activities (optional)

Certificate start date * Start date

Certificate start date required

Certificate end date * Max 14 days from start.

End date must be within 14 days of start

Individual sick notes can only be issued for a maximum of 14 days. Extensions can be issued if you remain unwell beyond 14 days.

For very retrospective sick notes we may request documentation indicating when you were affected by your illness.

Medical History

Almost done. These details help our doctors provide the most accurate certificate.

Underlying health issues / past medical history I have no underlying health issues or past medical history to declare.

Regular medications I take no prescribed or over-the-counter medications.

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

Medical Evidence (if available)

✓ Questionnaire completed — results will be sent with your submission.

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Tap to select files, or drag & drop

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Photo ID

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Tap to select your ID photo

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I will send my documents by email instead of uploading now.

Your mental health condition

One quick question so we know what evidence to ask you for.

Do you have an existing diagnosis or documentation of your mental health condition? *

Please select Yes or No

We’ll ask you to complete two short standard questionnaires (GAD-7 and PHQ-9) on the next step so the doctor can assess your condition.

Diagnostic Questionnaire

Please complete the following mental health questionnaires so that our doctors may better assess your condition.

These are standard clinical screening tools (GAD-7 and PHQ-9). Your answers are confidential and reviewed only by your doctor.

⚠️ Please answer all questions before continuing.

Review Your Submission

Please check everything is correct before submission.

✏️ Not sure about something? Tap any section below to go back and edit.

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 to continue

Complete Your Order

Reviewed by a GMC-registered doctor and delivered as a signed PDF to your inbox.

★★★★★

"2 hours — exactly what we needed, even outside office hours."

— M.E. L. · Trustpilot Verified

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Sick Note

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