Health Screening Form


For the purposes of obtaining a medical test and certificate(s) to participate in competitive and non-competitive sporting events. Please provide full and detailed information and answer all questions. Please note that incomplete, incorrect, submissions will be returned for re-submission.

Contact Details


Your GP


Please enter a contact telephone number for your GP.


Medical Condition


ft
in
cm
kg
lbs


Medical History


Have you ever suffered from any of the following diseases?

High blood pressure

Cardiac Arrythmias or Palpitations

Stroke

Heart Attack

Asthma

Bronchitis

Any Type Of Chronic Disease

Rheumatic Fever

Diabetes

Epilepsy

Thyroid Disease

Bleeding Disorders Such As Haemophilia

Heat Stroke

Water Intoxication

Any Other Medical Disorder


Heart Disease



Your Current Medication



Hospital


Your Training


How far are you cycling, running or swimming each week?

How long do you push your heart rate to 70% of its maximum for?

minutes
cigarettes per day
units per week

Performance Enhancing Drugs



Medical Insurance


Your Events




Terms and Conditions

I understand that the personal information being submitted is securely protected under GDPR 2018. I also understand that this will only be used to assist in my entrance event. I also state that all the data provided is present, correct and complete at the date it was submitted.

Disclaimer

Any medical certificate is void if it is later discovered that any information has been falsely disclosed or deliberately withheld. Please be advised that the medical certificate does not guarantee fitness for an event, but represents the considered opinion of the Doctor with all the information available at the time.

It should be understood that dynamic studies of cardiac function such as cardiac echo or cardiopulmonary excercise testing provide a much more accurate assessment of cardiovascular fitness, however this type of specialist testing is not required for the medical certification process unless clinically indicated. Read full disclaimer.


Certificate


Your health screening form will not be reviewed by a GP/Doctor, and therefore your certificate won't be issued, until you have completed payment.

Frequently Asked Questions


"What if my event requires full diagnostic testing?"

We are unable to perform such tests as ECG, urine analysis and spirometry tests online. We recommend that you make an appointment with a sports specialist for a face to face review.

"How long will it take?"

Please allow up to 2 working days during busy periods, but we aim to supply certificates within 24 hours.

"What if the Doctor needs to ask me more questions?"

If the Doctor needs to ask you further questions before they issue the certificate, they will contact you by e-mail or telephone.

"Do I have to pay if the Doctor can't issue a certificate?"

No you don't. If the Doctor feels you are not fit enough for the event, they will notify you via e-mail and you will not be charged for the service.

"What if I lose my password?"

You can request your password to be reset.

"What if I want to talk to a Doctor?"

Use the contact form above, and we can organise this for you.

1

Complete the online Health Screening Form

2

Pay the £65.00 fee securely via PayPal*

3

Doctors will assess if you are fit for your chosen event/s

4

Doctors send your certificate via e-mail

* All major debit/credit cards accepted. PayPal account not required.