Social Welfare Certs and Notes for Work

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SOCIAL WELFARE CERTS AND NOTES FOR WORK

Requests for Social Welfare Certificates and Notes for work may be dealt with using the form below.
Notes for work can usually only be provided following a consultation with a GP.
However, extensions may be processed without further GP consultation, depending on the individual circumstances
Please do not submit a request if nobody has seen you for your condition
There is no charge for Social Welfare Certificates
Notes for work and other letters may attract a fee (typically €20)
If we are unable to complete your request, a member of our staff will be in touch by telephone or by text (please consent to texts if you are happy to receive texts).

I have read and understand the above *

Yes

* Indicates required field

Name DOB Address Phone number *

PPS number *

Are you requesting *

A note for work A social welfare cert Something else/Other

Have you seen one of the doctors here with this condition? *

Yes No

Please provide information about the condition to be certified and include dates to be certified *

You may need to upload notes from other institutions, clinics or hospitals with this request please upload these below

Attach any relevant documents here *

Max file size: 20MB

If need to upload a 2nd document attach here *

Max file size: 20MB

Please allow 72 hours for request to be processed.

I acknowledge that cert/letter requests are processed within 3 working days, and that I will receive a phone call or text if a further GP consultation is required.

Letters will be required to be collected at the surgery and a fee will apply

GDPR: We will only use the information you provide us in this form to deal specifically with your request for certificate or letter and we will not use it for any other purpose.

I have read and understood the above *

Yes

I consent to texts from the surgery *

Yes No

Submit