Medical Certificate / Sick Note Template
Fitness-to-work / sick leave certificate signed by the attending clinician.
Use this free medical certificate / sick note template to create, fill in and sign a medical certificate / sick note online. Self-sign in your browser — tamper-evident audit trail included.
Template preview
MEDICAL CERTIFICATE
[clinic name]
Date: [date]
This is to certify that I examined [patient name] (ID: [patient id]) on [exam date].
Assessment
Diagnosis / reason: [diagnosis]
In my professional opinion the patient is [fitness status] and requires rest/leave from [leave from] to [leave to] ([leave days] days).
Clinician: [clinician name] Reg. No: [clinician reg no]