Verification of medical conditions form (SU684)

Use this form to verify medical conditions affecting your capacity to work if you need an Employment Services Assessment.

A medical practitioner must complete this form.

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.

 
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 19 July 2018