Sick and carer’s leave self-declaration certificate

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Important Notice:

Please note that Partner Practitioners are unable to facilitate requests for controlled or addictive medications, including substances classified under Class A, B, or C of the Misuse of Drugs Act 1971. Medications not prescribed include Diazepam, Endone, Lyrica, Zolpidem, Codeine (including Panadeine Forte), Benzodiazepines (including Valium/Diazepam, Temazepam, Oxazepam, Alprazolam), Duromine, Tramadol, Gabapentin, Pregabalin, Seroquel, Steroids, Vyvanse, Modafinil, Dexamphetamine, Ritalin, Concerta, Sofradex ear drops, and Roaccutane.
Consultation Details
What do you require from your Partner Health Practitioner?*

Prescription - Medication you have taken beforePrescription - Medication you have NOT taken before
Just need a Medical Certificate? Request one online and answer any questions via text.

<< Request Medical Certificate Online >>
Please note, your Partner Practitioner is unable to prescribe controlled substances under the Misuse of Drugs Act 1971.
Unfortunately, Partner Practitioners are unable to facilitate this type of consultation request.
Your Partner Practitioner will need to know: what your specific medical issue and symptoms are, your history of allergies, medication, and operations.*
Please provide as much specific information as possible so that your Partner Practitioner can provide an effective solution as quickly as possible to you.
Please specify your medication needs*
Do you have any allergies?*

YesNo
Please specify your allergies
Are you currently taking any medication?*

YesNo
Please specify which medication you're taking
Do you have any existing medical conditions?*

YesNo
Please specify which your existing medical conditions
Patient Details

Please ensure that you input the details of the person requiring medical advice.
Full name*

First nameLast name
Sex*

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Date of birth*

DayMonthYear
Example: 22/03/1990
NHS number
Leave blank if you don't have one
Address*
Address*

Street Address

Street Address Line 2

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PostcodeCountry
Email*

Confirmation Email
Mobile number*
Make sure to double-check you entered the correct number.
Proof of Identification (Passport, Driver's Licence, etc)

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If your Partner Practitioner determines that telehealth is not appropriate for your case, you will be refunded.

Priority options:

RECOMMENDED: Priority requestReviewed and issued by a UK practitioner, access delivered to you via email and SMS, with your request prioritised at the top of the queue.

£59.95

Regular requestReviewed and issued by a UK practitioner, acess delivered to you via email usually within the day.

£44.95

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Total

£0.00

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I confirm that I am not seriously unwell and I do NOT have any of the following symptoms: chest pain, shortness of breath, unable to swallow fluids or saliva, weakness or numbness down one side, slurred speech. I confirm I do not think I need to see a GP. If symptoms are related to a COVID vaccine, I will consult my GP or the medical professional who provided the immunisation. I confirm that this is not a replacement for a doctor's visit. I have read, understood and agree with the information in the terms of service and consent to the use of information in accordance with the privacy policy.*

Yes
IMPORTANT: You are making this request outside of operating hours. A health practitioner will call you during the operating hours of 9am to 10pm AEDT.
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Important Notice:

Consultation Details

Please note, your Partner Practitioner is unable to prescribe controlled substances under the Misuse of Drugs Act 1971.

Unfortunately, Partner Practitioners are unable to facilitate this type of consultation request.

Patient Details

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