Application Form | Unfit to Travel Medical Certificate
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Section 1: Your Details

Full Name
Your medical certificate will be sent here - please ensure this is correct.
Date of Birth
Address

Section 2: Reason for Certificate Request

Please indicate who you require this certificate for:

Section 3: Your Travel Plans

Section 4: Reason for Altered Travel Plans

Have you consulted your GP or physician, visited the Emergency Department, or sought advice from another healthcare professional regarding this issue?

Section 5: Anything Else? (Optional)

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

Section 6: Identity Verification

Are you a citizen of the United Kingdom?

Section 7: Additional Documents

We can complete and sign any extra documents needed for your travel or holiday cancellation or rescheduling. There is a one-time fee of £25 for any additional forms that require signing. If you have any questions about this, feel free to email us at hello@wilmerhealth.com, and you’ll receive a response within hours.

Do you have any other documents that need to be signed?

Terms and Conditions

By submitting your application, you agree to our Terms and Privacy Policy and confirm the following:

  1. You have carefully read and understood all questions in the questionnaire and have provided truthful, accurate answers.
  2. You confirm that you have submitted all necessary evidence and have not intentionally withheld any relevant information.
  3. The certificate you are requesting is for the individual whose name and details have been submitted in this form.
  4. Wilmer Health does not provide a service for diagnosis, consultation, or medical treatment, and no liability is accepted for any adverse events that may occur at any point in time.
  5. Our certificates are issued to confirm your reason for travel or holiday cancellation based on the information provided. They do not act as a guarantee, insurance policy, or medical indemnity. The certificate is not a substitute for a medical consultation.
  6. You agree to release Wilmer Health and its doctors from any liability in relation to any adverse events that may affect you or others.
  7. You understand that Wilmer Health is not a substitute for a traditional doctor’s visit, and its healthcare professionals do not have access to your NHS or other medical records.
  8. You acknowledge that Wilmer Health is not responsible if an employer or third party refuses or rejects your certificate or letter, and Wilmer Health is not liable for any associated costs.
  9. You acknowledge that once a doctor from Wilmer Health reviews your request and issues a letter, refunds are not possible.
  10. You agree to seek further medical advice from your regular doctor, GP, or local Emergency Department for any issues relating to your medical condition described in this application.
Agreement to Terms and Conditions

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