Request a Medical Certificate

Please use this form if you have recently seen a Doctor but forgot to obtain a medical certificate

    First Name*:
    Date of Birth*:
    Last Name*:
    Email*:
    Doctor*:
    Date of appointment*:If your appointment was over a week ago, please contact us on 1300 557 502

    Dates requested for Medical Certificate:

    Date from*:
    Date to*:

    Important notes:
    1. By providing your email address above, you are giving us permission to email you a soft copy of a medical certificate should it be provided by your Doctor.
    2. We will endeavour to respond to your request within 3 business days. We can not guarantee that your doctor will be prepared to issue a certificate for any day other than the day you attended the Clinic.