Use this form to verify medical conditions affecting your capacity to work if you need an Employment Services Assessment.
This form must be completed by a medical practitioner.
This is not a medical certificate. If you are seeking a temporary exemption from your Mutual Obligation or participation requirements because you are temporarily incapacitated for all work your treating doctor needs to complete a Medical Certificate.
If you use assistive technology because of a disability or impairment we provide help for assistive technology users of forms.