Free template
Medical certificate template
A certificate for an employer: unfit from, unfit to, fit to return, and any restrictions, signed and numbered.
Download the PDFFree, no sign-up. Fill it in on screen or print it.
What it asks for
What is on the formThe secretary completes
- Practice details, date issued and certificate number
- Patient: name, date of birth, PPS number, address, employer if disclosed, occupation
- Certification: unfit for work from and to, fit to return on, restrictions on return, review required
- First certificate, continuation or final
- Sign-off: name, qualifications and Irish Medical Council number
Using it well
- This is a certificate for an employer. Illness Benefit claims follow the Department of Social Protection's own certification process.
- Number certificates in sequence and keep a copy with the record.
- Include the employer only when the patient asks you to.
Open it in the sample practice
The sample practice is the real Ask Brigid on invented patients, open without a sign-up. This document joins its Library with the next sample-practice update; the Library already holds the practice’s templates.
Sources
- The shipped template's field list (Brigid stationery v12), read 24 October 2026
Checked against the sources above on 23 September 2026. Issuers change their forms; check the official page before you rely on a detail here.
In Ask Brigid this paperwork sits beside the diary and the record: Practice management for private consultants.