Sick Certificate Template

The Sick Certificate Template – Australia is available in several formats, including PDF, Word, and Google Docs. These formats are both customizable and print-ready, tailored to fit your requirements conveniently.

Template – (Open)

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Sample

Sick Certificate Template – Australia

Editable | Printable

(PDF – 1) (PDF – 2)

Complete Template Online

1. Patient Information

2. Doctor Information

3. Medical Condition

4. Dates of Absence
Start Date:
End Date:

5. Recommendations for Rest

6. Follow-Up Appointment
Next Appointment Date:

7. Declaration of Authenticity
I declare that the information provided is accurate and truthful to the best of my knowledge.

8. Signature of the Doctor
Doctor’s Signature:

Date of Issuance:

PDF

WORD

Examples

Sick Certificate Template – Australia (1)

Patient Information:
[Patient’s Name]
[Patient’s Address]
[Patient’s Phone]
[Patient’s Date of Birth]
[Patient’s Email]

Issuer Information:
[Doctor’s Name]
[Practice Name]
[Practice Address]
[Practice Phone]
[Practice Email]

Date of Issue:
[Date]

Subject:
This certificate is to confirm that the above-mentioned patient was examined on [Examination Date] and was found to be unfit for work due to the following medical condition(s):
[Medical Condition Details]

Duration of Illness:
The patient is advised to refrain from work for a period of [Number of Days] days, from [Start Date] to [End Date].

Recommendations:
It is recommended that the patient follows the prescribed treatment and attends a follow-up appointment on [Follow-Up Date].

Doctor’s Note:
This certificate is issued for the patient’s employer as proof of the medical condition affecting their ability to work.

Signed:
[Doctor’s Signature]
[Doctor’s Name]
[Medical Registration Number]

Sick Certificate Template – Australia (2)

Patient Information:
[Patient’s Name]
[Patient’s Address]
[Patient’s Phone]
[Patient’s Date of Birth]
[Patient’s Email]

Doctor’s Information:
[Doctor’s Name]
[Clinic Name]
[Clinic Address]
[Clinic Phone]
[Clinic Email]

Date of Issue:
[Date]

Reason for Certification:
This is to certify that [Patient’s Name] is suffering from [Medical Condition] and has been under my care since [Start Date of Condition].

Recommended Period of Absence:
The patient should be excused from work during the period [Start Date] to [End Date].

Further Instructions:
The patient is advised to limit physical activity and attend a follow-up consultation on [Follow-Up Date]. All health-related queries should be directed to [Contact Number].

Verification:
This certificate is issued to support the patient’s request for sick leave as per the company’s policy.

Signed:
[Doctor’s Signature]
[Doctor’s Name]
[Medical Registration Number]

Printable

PDF – 1 PDF – 2