Request a medical certificate | Dr Farukh Tehseen

Online certificate requests are open.

Complete the form below and pay securely on this page. For a regular appointment, book with Dr Tehseen on HotDoc.

Your details

Enter your details below. A clinician will speak with you before deciding whether a certificate can be issued.

First name *

Last name *

Date of birth *

Medicare card number *10 digits on your Medicare card, without the individual reference number.

Individual reference number *The single digit next to your name on the card.

Mobile number *

Email address *

Residential address

Street address *

Suburb *

State or territory *

Postcode *

Certificate dates

Requests are limited to today or a future date for up to two consecutive days. Certificates cannot be backdated.

First day requested *

Last day requested *

I understand a doctor must speak with me before deciding whether a certificate can be issued. If a certificate is not appropriate, the $25 fee will be refunded.

Secure payment

Card details will be entered through Stripe. They will never be collected by this form.

Medical certificate request$25.00

Your card details are entered securely with Stripe.

How your information is used

Dr Farukh Tehseen collects the details above to identify and contact you, assess your request, and manage the payment and any refund. Your request is encrypted in the website's patient intake database and is available to the doctor for review. Your email address is provided to Stripe for checkout; you enter card details directly with Stripe. If you do not provide these details, you cannot use this online request service. For questions or access to your information, contact dr_farukh@yahoo.com. Do not email medical details through the general contact form.