Queen's Road, Aberlour, AB38 9PR

Telephone: 01340 871210

Fax: 01340 882103


Current time is 15:55 - We're open

Request for Medical Certificates

To be completed by the requesting patient

  • Let us know what certificate or form that you would like us to process:
  • Full name of patient
  • Please give a number that you can be contacted on
  • Specify time(s) when you cannot take a call from our Clinical Administrators or GPs. Please try to be available as much as possible in order to give us the maximum chance to contact you.
  • Sick Note

    Please complete this part of the form if you wish the GP to consider processing a Sick Note:
  • Have you seen a GP during this illness?
  • Name(s) of the GP(s) that you have seen about this illness
  • Last date and time that you have seen a GP about this period of illness
  • What do you understand to be the diagnosis?
  • What symptoms are you currently suffering from :
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Anything that you feel may help the GP with the decision making
  • Vaccination Records

    Please complete this part of the form if you want a copy of your vaccination records
  • Indicate whether you want all or part of the vaccination records
  • Please enter the date parameters and anything else which will help us process your request
  • Declaration and Signature

  • This field is for validation purposes and should be left unchanged.