Ardara Health Centre

Medical Certificate Request Form

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To process your request you must provide us with your PPSN, start and finish date, indicate if the cert is for Social Welfare/Employer or both. All Social Welfare Certs are forwarded automatically through our system.
If it is your first Social Welfare claim for a particular period you will also need to complete a IB1 form. This can be done on line if you have a MyGovID and Public Services Card. You can use the link on our home page to complete IB1 online.
Hard copies of the IB1 are available in the Post Office and should be posted to Welfare. A Doctors signature is not required on this form.

If you are requesting a medical certificate for the first time in relation to a patticular period of illness you will be asked to make an appointment to see the Doctor.

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Date of Birth:


You must provide with an email address if you wish to receive a copy of you cert



Start and finish dates are inclusive

Start date:

Finish date: Employer:

Social welfare: