Request a Medical Certificate Please complete the below and our team will email you a copy of your medical certificate. Need some help? Click here to contact us, we will be happy to help. Patient name*Who is the medical certificate for?*The patientThe carerEmail address* Date of operation* Date Format: DD slash MM slash YYYY Type of operation*Please selectAdenoidsAdenoids grommetsCochlear ImplantEndoscopic Ear surgeryExostectomyGrommetsSeptoplastySepto/ Turbs/ FESSStapedectomyTonsilsTurbinoplastyUPPPOtherPlease detail 'other'*Who is your doctor?*Please selectA/Prof Nirmal PatelDr Leo PangDr Justin KongDr Fiona TingWhat is the certificate for?*Please selectWorkSchoolSportOtherPlease detail 'other'*Medical certificate START date* Date Format: DD slash MM slash YYYY Medical certificate END date* Date Format: DD slash MM slash YYYY Carer nameCare giver certificate START date Date Format: DD slash MM slash YYYY Care giver certificate END date Date Format: DD slash MM slash YYYY Email communications* I agree to receive email communications from The Sydney Hills ENT Clinic and it's associated entities. This iframe contains the logic required to handle Ajax powered Gravity Forms.