Online Medical Certificate Assessment

Please complete all fields below. Before completing this questionnaire, please read the Use of Health Information Statement.

Full Name

Date of Birth

Address

Email

Mobile Phone Number

I consent to allowing access to my medical record in order to receive appropriate medical care and improve this service

I consent to this provider contacting me in the future

I consent to a summary of this consult to be sent to my regular GP

I have read and I agree with the Use of Health Information Statement.

Have you had a recent short-term/minor illlness and require a medical certificate for work?

Can you confirm you are improving and or feel well, and do not require a clinical assessment by the pharmacist?

Please provide some brief details about your recent illness.

Current medications

Medical conditions

Medication allergy

Address

Thank you – we have received your assessment. Our pharmacy team will review the information you have provided and will contact you to confirm the details. If the service is appropriate for you, we will then send you a text message with a link to pay the $35 medical certificate fee. Your medical certificate will be issued electronically once the pharmacist has completed the assessment and payment has been received. If we consider that you require further clinical assessment, we will let you know.

Our Opening Hours

Monday-Thursday: 8:30-6pm
Friday: 8:30-5pm
Saturday: 10-2pm
Sunday: Closed

Wellworks Pharmacy
Taranaki Street

75 Taranaki Street
Te Aro
Wellington

hello@wellworks.co.nz
Phone: 04 555 0522