Secure online form

This service is not for emergencies. If you have severe symptoms or need urgent help, call 000.

Step 1 of 2

Medical certificate request

A doctor will independently assess the information you provide. A document is issued only when clinically appropriate.

1

Diagnosis Information

2

Your Details

Certificate Type *

Single Day Certificate

Multi-Day Certificate

Leave Type *

It's for me

It's for someone else (Carer leave)

This leave is from *

Work

Studies

Flight or Travel

What are your symptoms? *

Common cold

Flu

Diarrhea

COVID-19

Depression

Food poisoning

Migraine

Headache

Allergies

Back pain

Period pain

Toothache

Anxiety/Stress

Other

Please provide the timing and a description of your symptoms:

Start Date *

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