Sick and carer’s leave self-declaration certificate

Medical Certificate
Please provide the following information about your circumstances
I am seeking*

Sick LeaveCarer's Leave
The leave is from*

WorkStudies
Full name of the person who requires leave*

First nameLast name
Date of birth*

DayMonthYear
Example: 22/03/1990
Address*
Email*

Confirmation Email
Phone number to receive certificate via SMS in addition to email*
e.g. +91 12345 67890
The main reason for the certificate*

Common cold or fluMigrainePeriod painBack painHeadacheAnxiety, depression or stressOther
Please describe the timeline of your symptoms, the details of your symptoms, and if you would like anything specifically mentioned on the certificate. Please note that Partner Doctors cannot approve leave for past dates and cannot assess fitness for work.*
Are you currently taking any medication and for what condition?
If it's important for the doctor to know, what type of work do you do?
Optional file upload (discharge papers, doctor's letter, photo of your COVID test)

If your conditions are related to a recent treatment or hospital presentation you must attach this documentation
Cancelof
Proof of Identification (Passport, Driver's Licence, Medicare card, etc)

Cancelof
Dates for the certificate
From*

DayMonthYear
You cannot request a date in the past or in the future
To*

DayMonthYear
You can request up to a week in the future

Product Selection*

Regular Medical Certificate RequestThis will be reviewed and signed by an Indian doctor. It will be sent to you via email, usually delivered within the day.

399.00INR

Express Medical Certificate RequestThis will be reviewed and signed by an Indian doctor. It will be sent to you via email, usually delivered within the hour.

649.00INR

Enter coupon

Price: ₹399
You have chosen leave from study and not work, make sure this is correct as it will appear that way on the certificate
Please double check your details below. This will appear on the certificate and cannot be edited after submission.

Name: {fullnameofthepersonwhorequiresleave}
Date of birth: {dateofbirth}
Email: {confirmEmail}
Mobile: {mobileNumber}
Date from: {from1}
Date to: {to1}
Leave from: {theleaveisfrom}
Type of leave: {iamseeking}
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.*

Yes
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Medical Certificate

Please provide the following information about your circumstances

Dates for the certificate

Price: ₹399

You have chosen leave from study and not work, make sure this is correct as it will appear that way on the certificate