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Pre Consult Assessment Medical Certifate
Pre Consult Assessment Medical Certifate
Pre Consult Assessment
For your safety, we need to ask you some questions.At any stage if you feel very unwell or your symptoms get worse, you must seek immediate medical attention.
I confirm I am in Australia and my Qoctor profile (if previously registered) is up to date.
*
Yes
No
I confirm that I am not seriously unwell, I just need a medical certificate
*
Yes
No
I confirm that I do NOT have any of the following symptoms currently:
*
○ Chest pain
○ Shortness of breath
○ Unable to swallow fluids or saliva
○ Weakness or numbness down one side
○ Slurred speech
Yes
No
Have you ever had any of the following conditions? ( leave blank if none apply)
Cancer
Diabetes
Heart disease or heart attack
Stroke
Any condition or medication that can affect your immune system
I need a certificate for one of the following conditions (please select one)
*
Common cold or flu
Gastro
Migraine (have had before and been medically confirmed as migraines)
Period pain
Back pain
Headache
Anxiety, depression or stress
Have your symptoms lasted for 7 days or more?
*
Yes
No
Do you have severe tummy pain?
*
Yes
No
Are you dehydrated? (Dizzy, unable to drink sips of fluid, passing little or no urine)
*
Yes
No
Is there blood in your vomit or poo, or is your poo black and tarry?
*
Yes
No
Do you have any previous stomach or bowel conditions?
*
Yes
No
Have you had back pain for more than 7 days?
*
Yes
No
Do you have any of the following:
*
○ Back pain radiating into one or both legs
○ Pins and needles/numbness or around your anus or behind your genitalia
○ Any weakness in your legs
○ Loss of bladder or bowel control
○ Any urinary symptoms (for example, pain when passing urine or passing urine more frequently)
○ Any fever or ‘flu-like’ symptoms
○ Unexplained weight loss
Yes
No
Have your headaches been previously confirmed as migraine by your doctor?
*
Yes
No
Do you have a fever, flu like symptoms or confusion with your current headache?
*
Yes
No
Is your current headache far more severe than your previous migraines?
*
Yes
No
Have you had a head injury in the last 2 weeks?
*
Yes
No
Do you have uncontrolled hypertension (high blood pressure)?
*
Yes
No
Is there any chance you could be pregnant?
*
Yes
No
Do you have a fever or flu like symptoms?
*
Yes
No
Do you have any foul smelling/abnormal vaginal discharge?
*
Yes
No
Is this period pain much more severe than previous episodes?
*
Yes
No
Do you have any of the following:
*
○ Headache accompanied by neck stiffness
○ Discomfort when looking at bright lights
○ Rash which doesn't fade when you press on it
○ Difficulty in breathing
○ Chest pain
○ Coughing up blood/blood stained phlegm
○ Unable to swallow solids and fluids
Yes
No
What dates do you need the certificate for?
From
*
To
*
Please select a time slot for your video consultation from the drop-down menu below
*
1pm-2pm AEDT today
4pm-5pm AEDT today
8pm-9pm AEDT today
1pm-2pm AEDT tomorrow
4pm-5pm AEDT tomorrow
8pm-9pm AEDT tomorrow
Special Notes
I confirm I do not think I need to see a GP in person.
*
Yes
If my symptoms continue or get worse I will see my GP in person
*
Yes
Does your current health issue (reason for booking this appointment) relate to a legal matter, court appearance or a Workcover/insurance claim?
*
Yes
No
I have read and accept the terms and conditions.
*
Yes
In certain situations, a longer GP consultation will allow us to meet your needs more effectively. This includes:
*
○ If your university/employer requires an additional special form to be completed for your sick leave
○ If your sick leave started more than a week ago
○ If you have already had 2 or more medical certificates in the past 4 weeks
○ If you have a long term, recurring or complex medical condition
○ If you need to discuss other health issues
Do any of the above circumstances apply to you?
Yes
No
What's next?
• Click “continue” below to go to the next page, where you’ll complete the final steps of your booking.
• You’ll be asked to login if you haven’t already done so.
• When you have completed checkout, you’ll get a confirmation email.
• Later, you’ll get another SMS and email, 15minutes before your appointment slot, with a video link to your appointment.
Medial Cetificate
Total
$0.00
Please complete payment and then choose your appointment time.
The following times are available to book a consultation.
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