UK: New UpDoc Cert Form

Medical Letter Questionnaire
I am seeking:*

Sick leave from workFit to start workFit to return to workAdjustments to work dutiesSick leave from studiesFit to resume studiesChickenpox recoveryTravel & holiday cancellationPregnancy fit to fly
Your Details
Full name of the person who requires the letter*

First NameLast Name
Email*

Confirmation Emailexample@example.com
Mobile number*
e.g. 07438384646
Date of birth*

DayMonthYear
Ethnicity*
Sex*

MaleFemalePrefer not to say
Sex (for pregnancy letter requests) - hidden*

MaleFemalePrefer not to say
NHS number
Please leave blank if unsure or if you do not have an NHS number
Medical Questions
Medical Questions
Do you have any pre-existing health conditions your Partner Practitioner should be aware of?*

YesNo
Please provide information about your pre-existing health conditions.*
Are you taking any medications regularly?*

YesNo
Please provide information about your standard medication regimen.*
How far can you walk before you have to stop to catch your breath?*

Few hundred yardsLimited to 1 mileUnlimited
Personal Health Status
Are you currently suffering from any infectious diseases?*

NoYes
Are you presently sick due to any infections?*

NoYes
Did you ever have any infectious diseases in the past that necessitated isolation?*

NoYes
Have you previously been diagnosed with Tuberculosis?*

NoYes
Please detail any existing diseases or health conditions that you currently have. Please provide a timeline.*
NHS - GP Summary Care Record Upload

Provide images or screenshots of your NHS GP Summary Health Care Record. It should provide your current medical history, past medical history, current medications, and immunisations. You can request this 'Health Summary' from your GP. It may also be available in your NHS app, if you have linked it with your NHS GP Surgery.
Please upload your NHS - GP Summary Care Record

Optional field
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Please provide the address where we should send your certificate.

A hard copy of your certificate, signed in wet ink, is often needed for your visa application. We will mail you this signed certificate, free of charge, via Royal Mail, in addition to your digitally signed certificate.
Address*
Health Certificate - Country Confirmation
Specify the country requiring this health certificate.*
When is your estimated delivery date?*

DayMonthYear
Date
Is your pregnancy single or multiple?*

SingleMultiple
Did conception occur naturally or with the assistance of medical procedures (e.g., IVF, fertility treatments)?*

NaturallyWith the assistance of medical procedures
Please specify the method(s) used to conceive. *
Have you experienced any complications or adverse events during your current pregnancy?*

YesNo
Please specify the complications or adverse events experienced (e.g., hypertension, vaginal bleeding):*
Do you have a history of any of the following medical conditions?*

Anaemia/low blood cell countSickle cell disease or traitHistory of blood clotsHigh blood pressurePoorly controlled diabetes (high blood sugar)Complications during previous pregnancies (such as vaginal bleeding)Placental abnormalitiesHistory of early onset of labour (before 37 weeks)2nd trimester miscarriage(s)None of the above
Please confirm that your midwife does not advise against flying*

I have been medically advised that I may fly during my current pregnancyI have been medically advised NOT to fly during my current pregnancy
Please list any non-pregnancy related health conditions you currently have (e.g., asthma, migraine, chronic back pain):*
Are you currently on any prescribed medications?*

NoYes
Please list the medications you are currently taking (e.g., levothyroxine, aspirin):*
Where is your antenatal care being managed?*
What was your Body Mass Index (BMI) at the onset of your pregnancy?*

Underweight: Below 18.5Normal: 18.5-24.9Overweight: 25-29.9Obese: 30 or above
What was your latest antenatal clinic blood pressure reading?*

Low (below 90/60mmHg)Normal (over 90/60mmHg, below 140/90 mmHg)High (over 140/90 mmHg)
When was your most recent blood pressure reading taken?*

Within the last month1-3 months ago3-7 months agoOver 7 months ago
Your request
Please explain why you need a fit to start work letter.*

20 words minimum. What you type in here won't be added onto the letter.0/0
Symptoms
Your unforeseen illness or injury
Main reason for travel or holiday cancellation*

Serious illnessAcute injurySurgery or hospitalisationFlare-ups of chronic conditionMental health crisisDistress due to bereavementInfectious diseasePregnancy-related concerns or complicationsOther
Start date of symptoms*

DayMonthYear
Date you started to feel unwell
In one or more words, please describe your symptoms or condition*
Main reason for medical letter*

Common cold or fluHeadacheMigraineBack painPeriod painAnxiety, stress or depressionOther
Please describe the timeline and the details of your symptoms*

20 words minimum. What you type in here won't be added onto the letter.0/0
Do you want your Partner Practitioner to include health details and symptoms in your letter, or would you prefer a more generic approach to maintain privacy?

Yes, include specific health details and symptomsNo, maintain a generic approach for privacy
Have you sought medical care from your GP or local A&E for your medical issue?*

Yes, from my GPYes, I visited my local A&ENo
Please upload your A&E discharge summary, if available

Optional field
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What treatment was administered in A&E or by your GP?*
Video Evidence*

Please upload a 30 sec to 1 mins video describing your symptoms and reasons for requirement of a Sickness Letter for your workplace. Your medical information is confidential and will be reviewed by our team of Doctors as part of issuing your Sickness Letter.
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Condition Status*
Are your symptoms still ongoing, partially recovered or are you fully recovered?
Can you confirm that over the last 48 hours, no new spots have appeared, and that all the chickenpox spots have now scabbed over?*

YesNo
Have you had any fever within the last 48 hours?*

YesNo
Have you been in contact with anyone with Monkeypox?*

YesNo
How long do you need this for?

Please note, your Partner Practitioner may recommend different dates based on their professional judgment. They do not write notes for longer than 14 days at a time and are unable to backdate them.
Valid from*

DayMonthYear
Date
Valid to (inclusive)

DayMonthYear
Date
Confirm your flight details
Flight Date

DayMonthYear
Date
Outbound flight date*

DayMonthYear
Please note that most airlines will only accept letters dated within 14 days of your outbound flight. Check your airline's policy.
Airline*
What is the duration of your flight?*

Short-haul flight: 1-3 hoursMedium-haul flight: 3-6 hoursLong-haul flight: 6-12 hours
How far along will your pregnancy be at the time of your outbound flight (in weeks)?*
Number of weeks pregnant. Your Partner Practitioner is unable to certify you as fit-to-fly if your gestation is of 36 weeks or over by your flight date.
Do you have a return flight?*

YesNo
Please be aware that your letter, if suitable, may allow you to travel on the outbound flight, however it will not advise on your eligibility for a return flight.*

I understand that my Partner Practitioner will not advise on my eligibility for a return flight.
Return flight date*

DayMonthYear
Date
How far along will your pregnancy be at the time of your return flight (in weeks)?*
Number of weeks pregnant. Your Partner Practitioner is unable to certify you as fit-to-fly if your gestation is of 36 weeks or over by your flight date.
Confirm your identity

Please upload an image of your Passport, Drivers License or University/College/Workplace ID to confirm your identity.
Identity Document (and/or Student ID if applicable)*

Your photograph that is uploaded can be a PNG or JPEG image file, no larger than 20MB.
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Your workplace
I acknowledge that I do not hold any of the following roles for which fit-to-work notes cannot be provided: Any driving roles, motorsports drivers, HGV and bus drivers, taxi drivers, forklift drivers, ambulance drivers, crane operators, or work involving heights and scaffolding. Please confirm by selecting "I agree".*

I agree
Please confirm where you work*
Please describe your daily work activities*
What work adjustments do you require?*
e.g. To avoid using stairs, avoid pushing heavy objects
Your educational institution
Please confirm where you attend your studies*
Your NHS GP

Do you have a regular NHS GP?
NHS GP*
If Yes - please provide the name of your NHS GP Surgery ?
NHS Surgery
I confirm that I have fully understood the questions listed within this questionnaire and that they have been answered truthfully. I agree that any certification is only for the individual whose name and details were provided.*

Agree
Checkout

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

Priority options:

RECOMMENDED: Priority express request Product Image

RECOMMENDED: Priority express requestThis will be reviewed and signed by a UK practitioner. It will be sent to you via email and your request will be prioritised at the top of the request queue.

£60.00

Regular requestThis will be reviewed and signed by a UK practitioner. It will be sent to you via email, usually delivered within the day.

£45.00

Enter coupon

Total

£0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Confirm your details

Please double check your details below. These will appear on the medical letter, if suitable, and can't be edited after submission.
Name: {fullName}
Date of birth: {dateOf40}
Sex: {sex68}
Email: {email}
Mobile: {mobileNumber}
Letter type: {iAm}
Workplace: {workplace}
Symptoms start date: {startDate} ({conditionStatus})
Valid from: {validFrom}
Valid to (inclusive): {validTo}
Name: {fullName}
Date of birth: {dateOf40}
Sex: {sex68}
Email: {email}
Mobile: {mobileNumber}
Letter type: {iAm}
Workplace: {workplace}
Name: {fullName}
Date of birth: {dateOf40}
Sex: {sex68}
Email: {email}
Mobile: {mobileNumber}
Letter type: {iAm}
Workplace: {workplace}
Symptoms start date: {startDate} ({conditionStatus})
Name: {fullName}
Date of birth: {dateOf40}
Sex: {sex68}
Email: {email}
Mobile: {mobileNumber}
Letter type: {iAm}
Educational institution: {pleaseConfirm}
Symptoms start date: {startDate} ({conditionStatus})
Name: {fullName}
Date of birth: {dateOf40}
Sex: {sex68}
Email: {email}
Mobile: {mobileNumber}
Letter type: {iAm}
Educational institution: {pleaseConfirm}
Symptoms start date: {startDate} ({conditionStatus})
Valid from: {validFrom}
Valid to (inclusive): {validTo}
Name: {fullName}
Date of birth: {dateOf40}
Sex: {sex68}
Email: {email}
Mobile: {mobileNumber}
Letter type: {iAm}
Symptoms start date: {startDate} ({conditionStatus})
Name: {fullName}
Date of birth: {dateOf40}
Email: {email}
Mobile: {mobileNumber}
Letter type: {iAm}
Type of pregnancy: {isYour}
Estimated delivery date: {whenIs}
Airline: {airline}
Outbound flight date: {outboundFlight}
Outbound flight gestation: {outboundFlight89} weeks
Name: {fullName}
Date of birth: {dateOf40}
Email: {email}
Mobile: {mobileNumber}
Letter type: {iAm}
Type of pregnancy: {isYour}
Estimated delivery date: {whenIs}
Airline: {airline}
Outbound flight date: {outboundFlight}
Outbound flight gestation: {outboundFlight89} weeks
Return flight date: {returnFlight}
Return flight gestation: {returnFlight92} weeks
User Consent
Upon submitting your medical consultation, you acknowledge our Terms and Privacy Policy and consent to the following:
- You are NOT seriously unwell with any of the following symtoms: chest pain, shortness of breath, unable to swallow fluids or saliva, weakness or numbness down one side, slurred speech.
- You have comprehended the questions in the questionnaire and answered them honestly.
- The requested letter is solely for the individual with the provided name and details.
- updoc is not a replacement for a doctor's visit, nor is updoc your primary doctor or GP, and your Partner Practitioner may be unable to access your NHS or regular GP medical records.
- updoc facilitates access to private medical letters and does not issue Med3 notes, which are obtainable through your NHS GP for UK government benefits.
- updoc is unable to process refunds once your Partner Practitioner has reviewed your request and you've been sent a letter written by them. No exceptions.
- updoc cannot complete additional forms requested by your workplace, educational institution, or any other interested party.
- If your symptoms persist or you have not fully recovered, you agree to consult with your regular doctor or GP for further medical advice.
Calculation
Do you agree to the above Terms?*

Agree
Should be Empty:

Medical Letter Questionnaire

Your Details

Medical Questions

Medical Questions

Personal Health Status

NHS - GP Summary Care Record Upload

Please provide the address where we should send your certificate.

Health Certificate - Country Confirmation

Your request

Symptoms

Your unforeseen illness or injury

How long do you need this for?

Confirm your flight details

Confirm your identity

Your workplace

Your educational institution

Your NHS GP

Checkout

Confirm your details

User Consent