1-2 Days Medical Certificate for Carers Leave $19.95

First Name

Last Name

Code

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Are you required to care for someone today who is unable to care for themselves? *

Yes

Who are you the Carer for? *

Child

Spouse

Parent

Other

If other please describe below

Does the person you are caring for have any of the following symptoms: Fever over 39 degrees, extreme pain in the head or abdomen, vision disturbances, uncontrolled and excessive vomiting? *

Yes

Do you agree to seek further medical attention from your GP or local healthcare provider in the next few days if the person in your care has symptoms that persist or worsen? *

Yes

In your own words, please describe the current ailment. What are their symptoms?

How long have they had these symptoms?

What date will you start your leave?

Is there anything else you would like to add?

Do you understand all of the above questions and information that you have been asked to provide? *

Yes

Once approved by a pharmacist, your medical certificate will be sent via email.

The medical certificate will be issued for up to 2 days leave.

If symptoms persist or worsen please seek further medical attention from a local medical facility.

You're nearly there. Time to put your feet up!

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