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Illness Certificate
support@truedesign.ie
2026-03-26T11:30:49+00:00
Illness Certificate
"
*
" indicates required fields
Name
*
Date of Birth (DD/MM/YYYY)
*
Phone
*
Email
*
Cert Start Date
*
Cert End Date
*
Address
*
Street Address
County
Eircode
Reason For Cert (Optional)
Confirm Cert Extension
*
I confirm that I am requesting an extension of an existing cert. (Please make an appointment to see a GP if you have a new medical issue.)
Consent
*
I consent to being contacted about this request.
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