Diagnosis
Certificate Type
Single Day Certificate
Multi-Day Certificate
Leave Type
It's for me
It's for someone else (Carer leave)
This leave is from
Work
Studies
Flight or Travel
What are your symptoms?
Common cold
Flu
Diarrhea
COVID-19
Depression
Food poisoning
Migraine
Headache
Allergies
Back pain
Period pain
Toothache
Anxiety/Stress
Other
Please provide the timing and a description of your symptoms:
Start Date
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