WPForms Test – Sweta – Support

Section 1: Applicant Information

Full Name

First

Last

Gender

Email Address

Date of Birth

Mobile Number

Place of Birth

Required by many European event medical certificates

Place of Current Residence

Required by many European event medical certificates

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Section 2: Basic Health Information

Weight

Height

Most Recent Blood Pressure Reading

Do you currently smoke?

Yes
No

How much do you smoke?

Weekly Alcohol Consumption

Section 3: Medical History

Do you have any of the following conditions?

Asthma

Yes
No

Bleeding or Clotting Disorders

Yes
No

Chronic Obstructive Pulmonary Disease (COPD)

Yes
No

Irregular Heart Beat or Arrhythmia

Yes
No

Diabetes

Yes
No

Epilepsy

Yes
No

Any Heart Conditions?

Yes
No

If you selected 'YES', please give us further information:

Previous Heart Attack

Yes
No

High Blood Pressure

Yes
No

Stroke

Yes
No

Lung Disease

Yes
No

If you selected 'YES', please give us further information:

Section 4: Further Medical History

Have you ever experienced any of the following during physical activity?

Chest pain or discomfort

Yes
No

If you selected 'YES', please give us further information:

Severe shortness of breath

Yes
No

If you selected 'YES', please give us further information:

Fainting, collapse or loss of consciousness

Yes
No

If you selected 'YES', please give us further information:

Palpitations or an abnormally rapid heart beat

Yes
No

If you selected 'YES', please give us further information:

Section 5: Family Medical History

Is there any history of sudden cardiac death among close family members?

Yes
No

If you selected 'YES', please give us further information:

Section 6: Other Medical Information

Do you have any other chronic illnesses or conditions?

Yes
No

If you selected 'YES', please give us further information:

Any other medical conditions you would like us to be aware of?

Yes
No

If you selected 'YES', please give us further information:

Have you been admitted to a hospital in the last 24 months?

Yes
No

If you selected 'YES', please give us further information:

Have you consulted your GP recently?

Yes
No

If you selected 'YES', please tell us why:

Are you currently taking any prescribed medication?

Yes
No

Please list all the medications you take here:

Section 7: Athletic and Event Information

Weekly Training Routine: Please describe your typical weekly physical activities

Previous Sporting Events: Have you previously participated in any athletic events?

Yes
No

Which events have you participated in?

Section 8: Current Athletic Event

Which event(s) do you need this certificate for?

If your event has a specific form for a doctor’s signature and stamp, please upload it here.

Click or drag files to this area to upload. You can upload up to 100 files.

If your sporting event requires a specific form or certificate to be signed and stamped by a doctor, please upload it here. If no specific template is provided by the event organizers, we will issue our own standard sports medical certificate, complete with a doctor’s signature and stamp.

Section 9: Identity Verification

Please upload a clear image or copy of an identification document (e.g., passport, driving license)

Click or drag files to this area to upload. You can upload up to 100 files.

Section 10: Additional Information (Optional)

If there’s anything else you’d like us to know, feel free to add it here. (Optional)

Leave empty if you have no additional information to add.

Do you have any other relevant documents to upload? (Optional)

Click or drag files to this area to upload. You can upload up to 100 files.

Leave empty if you have no additional documents to add.

Terms and Conditions

By submitting your application, you agree to our Terms of Service and Privacy Policy, and confirm the following:

You affirm that you have fully understood all the questions in the application form and have answered them truthfully and to the best of your knowledge.
The certificate or letter requested is solely for the individual whose details are provided in the application.
You acknowledge that Fit Certify does not substitute a visit to your doctor, is not your primary healthcare provider, and its professionals do not have access to your medical records.
You understand that once a Fit Certify doctor has reviewed your request and issued a signed certificate, the service is deemed complete, and no refunds will be issued.
You accept that Fit Certify and its doctors cannot be held responsible if a third party rejects or fails to accept the certificate or letter, and neither Fit Certify nor its doctors will be liable for any associated costs.
You confirm that all the information you have provided is accurate and complete as of the date of submission.
You understand that any certificate issued by Fit Certify will be considered invalid if it is later discovered that relevant information was omitted or inaccurately provided.
You acknowledge that Fit Certify does not offer diagnosis, consultation, or treatment services. No liability is accepted for any adverse outcomes that may arise for you or any other individual at any time.
You agree that both Fit Certify and its doctors will not be held liable for any negative outcomes that may occur to you or others at any time.
You recognise that the sports medical certificate issued reflects the doctor’s professional opinion based solely on the information provided and the limitations of an online platform. It does not guarantee your fitness for the event.
You acknowledge that the certificates issued by Fit Certify are intended to satisfy the requirements for participation in specific sporting events. They are not a guarantee against health risks during physical activity.

Agreement to the Terms and Conditions

I acknowledge that I have read and accept the Terms and Conditions.

Checkout

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Sports Medical Certificate

Price: $60.00

Card

Name on Card