Covid Certification

IF YOU HAVE COVID AND ARE UNABLE TO ATTEND WORK YOU MAY BE REQUIRED TO PROVIDE THEM WITH CERTIFICATION.
FOR US TO PROVIDE WORK CERTIFICATION WE WILL REQUIRE YOU TO DISCUSS YOUR ILLNESS WITH RECEPTION AND THEN SUBMIT AN IMAGE OF THE POSITIVE TEST USING THE FORM BELOW

UPLOAD A PICTURE OF YOUR COVID TEST

* Indicates required field

I understand the image I am uploading will be visible to all practice staff *

I have told a staff member I am uploading an image of my covid test *

What is the start date and finish date of your covid illness to be certified *

Which member of practice staff asked you to forward this image, we ask this as unsolicited images are deleted *

Your Name (if submitting on behalf of patient) *

Your contact details *

Name of the patient *

Date of Birth of the Patient *

If submitting on behalf of a patient have they consented to their image being uploaded *

Upload image using this button *

Max file size: 20MB

Submit

Contact Us
133 St Peter's Rd, Walkinstown, D12XN9F
Ph switch 4504168 Fax 4783175

23 Old Bawn Way, Tallaght, D24 TKP0
Ph switch 4504168