Personal Leave Certificate

+61 (2) 9412 1036 | info@dayoffwork.com.au

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Personal Leave Certificate

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Leave Certificate
Personal Leave Certificate

Personal Leave Certificate

Acknowledgement

Certificates will be issued based upon the opinion of a Pharmacist and not a Doctor, using the information provided. A Pharmacist is not a Medical Practitioner.

Fill out the consultation form on this page.

Answer all questions and complete the payment process.

Wait for your email from the Pharmacist Team that will provide a link to connect with a Pharmacist at a nominated time.

The following consultation will be conducted for the purpose of assessing an individuals fitness to work. It is not intended to replace medical treatment, opinion or diagnosis.

If the injury/illness persists or worsens, the individual/member should seek advice from their General Practitioner. By continuing, you confirm that you are in Australia and that your illness is appropriate for requesting online personal/carer's leave certificate.

Yes, I understand

Your leave date*

DD slash MM slash YYYY

Your Full Name*

First Last

This name will appear on your certificate

Your Phone Number*

Please enter a phone number we can call you on.

Please supply your email address*

We will conduct the Pharmacist consult using Microsoft Teams and will send a link to your email.

Residential Address*

*We need this to confirm your identity.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Condition relating to certificate application*

Covid-19

Cold/Flu

Headache/Migraine

Physical Injury

Allergies

Other

Condition*

Symptoms

Briefly describe the condition and Symptoms you are experiencing.

How long have the symptoms been present for*

Less than 24 hours

24 - 48 hours

More than 48 hours

Have you consulted a doctor in relation to the illness/injury?*

Yes

Have you already received a leave certificate for the current illness/injury?*

Yes

What treatment or medication have you used for this illness/injury?*

Please list any prescribed or over the counter medications, creams, lotions, ointments and/or any other recommedations

What amount of leave have you already had off work as a result of the illness/injury?*

How many days in total have you had away from work?*

How many days leave do you believe you require?*

Product Name

Total

FEEL FREE TO CONTACT US

+61 (2) 9412 1036

info@dayoffwork.com.au

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