Application Form | Allergy Medical Certificate

Section 1: Your Details

Name

First

Last

Mobile Number

Your certificate will be sent to this email address

Sex

Date of Birth

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Section 2: About Your Allergy

Please describe the type of allergy you are affected by:

What happens if you are exposed?

Section 3: Upload Allergy Evidence

Please upload an IMAGE of a document that confirms you have been diagnosed with this allergy:

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

Examples include an image of your medical records or NHS app, a previous doctor's letter, summary care record from GP health records or similar documentation.

Do you take or carry any medications for this allergy?

Section 4: Identity Verification

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

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

Anything Else? (Optional)

Is there anything else you'd like to add before submitting your application? (Optional)

Are there any other files you would like to upload as part of your application? (Optional)

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

Terms and Conditions

By submitting your application, you acknowledge that you have read and agree to our Terms and Privacy Policy, and you consent to the following:

You have carefully read and understood all questions in the medical questionnaire and have provided truthful, accurate answers.
You confirm that you have submitted all necessary evidence and have not intentionally withheld any relevant information.
The certificate you are requesting is specifically for the individual whose name and details have been submitted in this form.
Wilmer Health does not provide a service for diagnosis, consultation, or medical treatment. The certificate is not a substitute for a traditional doctor’s visit or medical consultation.
Wilmer Health’s healthcare professionals do not have access to your NHS or other medical records and do not act as your primary care provider.
The certificate is not a guarantee, insurance policy, or medical indemnity. It solely reflects the information provided by you during the application process.
You agree to release Wilmer Health and its doctors from any liability related to adverse events or outcomes that may arise from the use of this certificate.
You acknowledge that Wilmer Health is not responsible if an employer, institution, or other third party refuses or rejects your certificate and is not liable for any associated costs or consequences.
You acknowledge that once a doctor from Wilmer Health reviews your request and issues a letter, refunds are not possible.
You agree to seek further medical advice from your regular doctor, GP, or local Emergency Department for any issues relating to your allergy or medical condition described in this application.

Agreement to Terms and Conditions

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

Checkout

Checkout securely below

Allergy Confirmation Certificate

Price: £45.00