Application Form | Visa Medical Certificate - Thailand

Section 1: Your Details

Full Name
Date of Birth
Address (your physical copy will be sent to this address)

Section 2: Medical History

Are you currently affected by any infectious disease?
Do you currently have or have you ever had Tuberculosis (TB)?
Have you ever had any infections that required isolation in the past?
Do you have any other health conditions or medical conditions?

Section 3: Upload Your Medical Summary / Primary Care Record

A Medical Summary is a document that outlines key health information held by your primary care provider. You can obtain this by downloading or taking screenshots from your online patient portal or health app, or by requesting a copy directly from your GP, family doctor, or primary care clinic. If you are unsure how to access your medical summary, please contact your healthcare provider directly or email us at hello@wilmerhealth.com , and our team will be happy to assist.
Drag & Drop Files, Choose Files to Upload You can upload up to 100 files.

Section 4: Identity Verification

Drag & Drop Files, Choose Files to Upload You can upload up to 100 files.
Please upload a copy of your passport so we can verify your identity and ensure your full name is correctly displayed on your medical certificate.

Section 5: Anything Else? (Optional)

Drag & Drop Files, Choose Files to Upload You can upload up to 100 files.

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. You acknowledge that 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. You acknowledge that our certificates are provided to confirm, based on the information you submit and your Summary Care Record, that you have none of the diseases specified by the International Health Regulations (IHR) 2005. 
  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 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.
  8. You acknowledge that once a doctor from Wilmer Health reviews your request and issues a letter, refunds are not possible.
Agreement to Terms and Conditions

Delivery Options

A physical copy with a wet-ink signature will be mailed to your address. Please select a postal delivery option below:

Please select a delivery option
*Please note: Next day delivery is only available if your order is placed before 3pm.

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Price: £79.00
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