UEA Medical Certificate Request Form

UEA Medical Certificate

This form can only be used if you have already seen a doctor or nurse at the UEA Medical Centre recently, about the condition concerned.

Medical certificates are not given for illnesses that last less than 3 days, unless the illness coincides with a course test, assessed practical, seminar presentation or an essay deadline.

You may still need a further appointment to discuss the certificate – we will contact you if this is the case, otherwise, the completed certificate will be emailed directly to you (to the email address you supply when you request the certificate). It is your responsibility to then email this to UEA.

IMPORTANT: Did you know that you can self-certify twice per academic year (for a max of 3 working days) for exceptional circumstances?

If your illness or other exceptional circumstances will last longer than 3 working days – use this form.

If you are seeking evidence of a disability, please use this form.

Check out the UEAs regulations regarding certificates at my.uea.ac.uk

Name

First

Last

Date of Birth

Confirm Email

Phone number

Student Number

School

Current year of study

Reason for certificate request

Other…

Name the illness/exacerbation of illness that has affected your work

0 of 150 max words

Date seen by the Doctor for this illness

Requested certificate START date

Requested certificate END date

Acknowledgement

I understand a certificate can only be granted based on information held in my medical record and in line with expected duration of my illness

I understand the certificate will be sent to me at the email address I have provided

I understand it is my responsibility to pass this certificate onto the UEA

If you are human, leave this field blank.