MED3 Request Form

MED3 Request Form

If you have been ill for more than 7 days you will need a doctor’s certificate. These certificates are called ‘Fitness To Work’ Certificates (MED3). You DO NOT require a medical certificate for absence from school or college - a MED3 certificate evidences your eiligibility for work and unemployment related benefits only.

Please allow 2 working days for your request to be processed

  • Your Details

    Date of Birth
    For example, 15 3 1984

  • Details of condition requiring a medical certificate (MED3)

    FIRST DATE YOU WERE NOT AT WORK DUE TO THIS ILLNESS
    For example, 15 3 1984
    When does your current sick line run out/need renewed?
    For example, 15 3 1984
    How would you like your Medical Certificate (MED3) to be made available?
    This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.
This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Page last reviewed: 15 December 2025
Page created: 15 December 2025