Apply For a Fit-to-Work Medical Certificate

Apply For A Fit-to-Work Medical Certificate

Please fill in the medical questionnaire below and one of our doctors will review the information submitted. Once approved, your fit-to-work certificate will be sent to your email address. If we are unable to provide you with a certificate, you will be issued with a full refund. If you need any support, please reach out to us at info@merlinhealth.co.uk - you can expect a response within hours.

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Your Details

Full Name *

First

Last

Mobile Number *

Email *

Your medical letter will be sent to this email address

Date of Birth *

Sex *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Your Workplace

Name of Workplace *

Address of Workplace *

Why You Need A Fit-to-Work Certificate

Why do you need a fit-to-work certificate? (you can select more than one option)

Returning to work after sickness period
Starting a new job role
Workplace Adjustments (e.g. support working from home etc)
Other

If you selected other, please give us detailed information here: *

About The Job Role

What is your job role? (e.g. teacher, accountant etc) *

What does your job role involve on a day-to-day basis? *

Does your work involve any risk to yourself or others? *

If yes, please give us further information about the risk involved: *

Does your work involve any of the following? (please select an option) *

My work involves none of these
Professional driving e.g. taxi, HGV, bus, forklift, train etc
Working at heights
Healthcare professional
Working with heavy machinery
Working on an airplane
Working in the army, navy, airforce or similar services
Working under water or at sea

Returning To Work After Sickness Period

When did your sickness period start? *

Current Health Status *

When do you plan to return to work? *

Why were you off sick? (please include as much detail as possible) *

Did you seek advice from your GP, A&E or another healthcare professional for this issue? *

If yes, who with or where did you seek medical attention? (e.g. GP, A&E etc) *

Please give us some further details about what happened during this consultation and what the outcome was: *

Can you provide us with any documents confirming that you sought medical attention? (e.g. GP health record, clinic letter, NHS App screenshot etc) *

Please upload any documents or files here: *

Click or drag files to this area to upload. You can upload up to 100 files.

If you selected no, why have you been unable to seek medical attention for this issue? *

Do you have any other ongoing or past health conditions? *

If yes, please give us further details here about ongoing or past health conditions: *

Were you recently or do you currently take any medication? *

If you selected yes, please list your medications here: *

Do you feel well enough to return to work? *

If you selected no, please tell us why here: *

Do you need any workplace adjustments to help you return to work safely? *

If you selected yes, please tell us what kind of workplace adjustments you think you need: *

Your Medical History

Do you have any ongoing or past health conditions? *

If you selected yes, please give us further information here: *

Do you currently take any medication? *

If you selected yes, please list the medications you take here: *

Do you smoke? *

How much do you smoke? *

Do you take alcohol? *

How much alcohol do you take in a typical week? *

Do you have a history of drug or alcohol misuse? *

If you selected yes, please give us further detailed information here: *

Are you aware of any health conditions which may affect you carrying out your day-to-day duties as part of your new job role? *

If you selected yes, please give us further detailed information here: *

Workplace Adjustments

Why do you need workplace adjustments? *

What kind of workplace adjustments would you like? *

Anything Else? (Optional)

Is there anything else you would like us to know about your application? (Optional)

Are there any other additional documents you would like to upload to support your application? (Optional)

Click or drag files to this area to upload. You can upload up to 100 files.

Identification Verification

Please upload a clear IMAGE of a form of photographic ID to verify your identity (e.g. passport, driving license) *

Click or drag files to this area to upload. You can upload up to 100 files.

Upload your NHS Summary Care Record

An NHS Summary Care Record is a document that summarises important health information from your medical record. You can obtain this either through your GP surgery, or you can download it from your NHS app or online healthcare records. If you are unsure about how to obtain this, please get in touch with your GP surgery or email us at info@merlinhealth.co.uk.

Please upload a copy, images or screenshots of your Summary Care Record here: *

Click or drag files to this area to upload. You can upload up to 100 files.

Terms and Conditions

Upon submitting your application, you acknowledge our Terms and Privacy Policy and consent to the following:

(1) You are NOT seriously unwell with any of the following symptoms: chest pain, shortness of breath, unable to swallow fluids or saliva, weakness or numbness down one side, slurred speech, thoughts of self harm or suicide. If you believe you are seriously unwell, we advise you to call emergency services (999) or speak to your registered doctor immediately.

(2) You have comprehended the questions in the questionnaire and answered them honestly.

(3) The requested letter is solely for the individual with the provided name and details.

(4) You are aware that Merlin Health is not a replacement for a doctor's visit, nor is Merlin Health your primary doctor or GP, and healthcare professionals at Merlin Health are unable to access your NHS or regular GP medical records.

(5) You are aware that Merlin Health facilitates access to private medical letters and DOES NOT issue MED3 notes, which are obtainable through your NHS GP for UK government benefits.

(6) You are aware that Merlin Health cannot complete additional forms requested by your workplace, educational institution, or any other interested party.

(7) You are aware that at Merlin Health, we do not offer a diagnosis, consultation or treatment service. No liability is accepted for any adverse events affecting you or any other party at any point in time.

(8) You agree to absolve both Merlin Health and our doctors of any liability for any adverse events affecting you or any other party at any point in time.

(9) You are aware that Merlin Health is unable to process refunds once our doctor has reviewed your request and you've been sent a letter written by them.

(10) You are aware that if an employer or third party does not accept or rejects a Merlin Health letter or certificate, for any reason, neither Merlin Health nor our Doctors are responsible for any costs incurred.

(11) You agree to consult with your regular doctor, GP or nearest Emergency Department for further medical advice regarding the medical issue you have described today.

Agreement to Terms and Conditions *

I have read and agree to the Terms and Conditions listed above

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Fit-to-Work Certificate

Price: £45.00