Medical Excuse Letter Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 57Email *NextFirst Name *Last Name *PhoneNextDate of Birth *Check to confirm date of birth *Check to confirm date of birthGender *MaleMaleFemaleWeight *Height *4' 0"4' 0"4' 1"4' 2''4' 3''4' 4''4' 5''4' 6''4' 7''4' 8''4' 9''4' 10''4' 11''5' 1''5' 2''5' 3''5' 4''5' 5''5' 6''5' 7''5' 8''5' 9''5' 10''5' 11''6' 1''6' 2''6' 3''6' 4''6' 5''6' 6''6' 7''6' 8''6' 9''6' 10''6' 11''7' 1''7' 2''7' 3''7' 4''7' 5''7' 6''7' 7''7' 8''7' 9''7' 10''7' 11''RaceSelectAlaska NativeAmerican IndianAsianBlack/African AmericanHawaiian or Other Pacific IslanderHispanicWhiteOtherOther Race *Marital StatusSelectSingleMarriedDivorcedSeparatedPreviousNextWho is the patient? *Myself (the patient)Myself (the patient)Pediatric (2-17 yrs old)FriendPreviousNextWhat disease are you suffering from? *PreviousNextSelect Your Location *TexasTexasKansasGeorgiaFloridaNevadaMississippiLouisianaAlaskaSouth CarolinaSouth DakotaAlabamaArkansasNew MexicoLet's match you with an authorized medical professional in your state.PreviousNextConsent to use information *We kindly request your consent to use the information collected during your interactions with our platform, to ensure transparency and data protection. Visit our privacy policy for more informationPreviousNextAuthorization to administer treatment and informed consent *I thus give my consent for the medical staff at ReddyDoc to examine my medical background and provide telemedicine (synchronous or asynchronous) healthcare to me, the patient.In the event that my chosen or preferred prescription is possibly hazardous, unsafe, controlled, risky, interacts with another medication I'm taking, or has an adverse drug reaction, I thus give ReddyDoc permission to prescribe an alternate drug.According to what I've been told, telemedicine services are only appropriate for mild to moderately complex medical requirements. I am aware that ReddyDoc will refuse to treat patients with serious or complex diseases and will cancel their appointments.I am aware that, in the absence of a physical examination, ReddyDoc will deliver online medical services based on the medical history I submit. I thus accept full responsibility for any injury or losses that may result from providing false, misleading, or incomplete information.I am aware that using telemedicine has a risk of misdiagnosis because there is no physical exam or in-person evaluation.I consent to phone 911 or follow up with a doctor for an in-person assessment if my symptoms get worse or don't get better quickly.PreviousNextTerms of use *I am aware that if my medical practitioner needs more information or if I submit insufficient medical history, the process could be delayed.I am aware that the consultation charge does not cover the cost of the medicine if I decide to pick up my drug(s) from a pharmacy; I will still be responsible for paying that pharmacy.I've been told that I can use my insurance to pay for my medication at the drugstore.I understand that I must email ReddyDoc to request an alternate medication or out-of-pocket (self-pay) options if my insurer is unable to pay for the required test or medication, or if the cost of the medication is prohibitive. I've been told that insurance restrictions or prescription costs are not acceptable justifications for issuing a refund. The patient is financially accountable for their prescriptions and medical services.PreviousNextDo you have a life-threatening symptom or a medical emergency? *YesNo life-threatening symptomsWe do not, unfortunately, treat life-threatening disorders. Please call 911PreviousNextAre you focused and alert? *YesNoYou must be focused and aware.PreviousNextAre you allergic to any medications? *No, there are no medication allergies (NKDA).YesWhat drugs do you have an allergy to? *PreviousNextDo you have any underlying medical issues? *I have no chronic medical or psychiatric issuesHeart diseaseHypertensionLiver diseaseKidney diseaseDiabetesHigh cholesterolThyroid disorderPsychiatric conditionHIV/AIDSOther ConditionList any further health issues you may have. *PreviousNextType of heart issue *Coronary Artery Disease (CAD) or heart attackHeart Valve DiseaseArrhythmias or abnormal heartbeatHeart Failure or CHFCongenital Heart DiseaseCardiomyopathy (Heart Muscle Disease)Pericardial DiseaseOtherList other heart conditions that you have *PreviousNextWhat is the average reading of your blood pressure? *Normal (Less than 140/90)Elevated (Less than 160/100)Uncontrolled (Over 160/100)PreviousNextType of liver diseasePreviousNextType of kidney disease *Kidney stonePolycystic Kidney DiseaseKidney infection or cystNephritis or nephropathyKidney cancerElevated creatinine or low GFRSolitary or Single-functioning KidneyOtherList other kidney disease *PreviousNextHow stable or controlled is your diabetes? *Well controlled (Glucose below 150 or Hba1c less than 8)Somewhat controlled (Glucose below 200 or Hba1c less than 9)Uncontrolled Diabetes (Glucose over 200 or Hba1c over 9)PreviousNextLast thyroid test *Normal TSH level in the last 12 monthsElevated TSH (or low T4 or T3) levelLow TSH (or low T4 OR T3) levelNo thyroid lab test in the last 12 monthsI have symptoms of abnormal thyroid disorderPreviousNextChoose applicable psychiatric condition *DepressionAnxietyPanic disorderBipolar or mood disorderSchizophrenia or psychosisPTSDEating disorderOCDOtherList other psychaitric condition *PreviousNextAre you currently taking any medication? *NoYesEnter medication name *PreviousNextMedication Disclosure Clause *I hereby certify that I am NOT currently taking any medication including OTC or supplements, and agree to indemnify and hold ReddyDoc and its employees harmless from any loss, damages, liability, legal liability and expenses resulting from withholding or non-disclosure of my medication or any other vital medical informationPreviousNextChoose Relevant Surgical History No surgical historyAppendectomyImplanting breastsC-sectionSurgery to remove the gallbladderHysterectomyHernia repairMastectomyOrthopedic surgeryTonsillectomyVarious surgeriesList any more operations you had in the past. *PreviousNextChoose the relevant social historyNon-smokerDrink Coffee multiple times a dayCurrent smoker (Vape, cigarette or tobacco)Former cigarette or tobacco usePrescription drug addictionAlcohol addictionPreviousNextWhen was your last in-person visit to the doctor? *Within the past three(3) monthsWithin the last three (3) to six (6) monthsWithin the last six (6) to twelve (12) monthsMore than a year agoNever met a doctor in personPreviousNextWhat Kind of Medical Letter is Requested?An invitation letter to return to work or studyA letter of absence from work or educationPreviousNextHow many days are you expecting to miss of work or school? *Three daysTwo daysOne dayFour or more days.STOP! Sadly, we do not provide this service.PreviousNextWhen do you intend to resume your studies or employment? *TodayTomorrowIn the next 48 to 72 hoursIn the next 48 hoursOtherPlease specify *PreviousNextSelect a justification for skipping work or school.COVID-19 positiveShowing COVID-19 symptomsMinor illness, unrelated to COVIDClose touch with a COVID-19 patient Minor injuriesPregnancyInjuryA life-threatening illness or other medical emergency when pregnantDisabilityMentally illOtherOther justificationsSTOP! Unfortunately, this is not a service we offer.PreviousNext Please provide an elaborate explanation as to why you are requesting this medical letter. *PreviousNextHave you spoken with a medical expert about this issue?Yes, I spoke with my provider about it.I received a Reddydoc evaluation.No! I have not spoken with any healthcare professionals.Describe your interaction with the doctor. *PreviousNextDoes the patient currently have any severe symptoms? I have COVID-19 symptomsI am experiencing additional worrisome symptoms.Currently, I do not have any significant symptoms that would hinder me from returning to school or work.Explain our symptoms *PreviousNextWhat's the Patient's COVID status? COVID-19 positiveCOVID-19 negativeFully immunizedPartially ImmunizedImmunizedPreviousNext Is the patient currently stable and well enough to safely return to school or work, as well as engage in other regular activities? *Yes, I confirm that the patient is asymptomatic and stable, enabling them to resume regular activities safely without delay.I hereby certify that the patient's health is not stable enough at this time for them to return to their regular activities.Give a strong justification for how you may safely continue your studies or employment. *PreviousNextDo you have any medical records or other documentation that demonstrates your ability to resume routine activities safely? *YesNoPreviousNextProvide Supporting Medical Record This will help us safely clear you for work/schoolFile Upload Click or drag files to this area to upload. You can upload up to 3 files. PreviousNext Has your employer, school, or organization been informed about this situation? *YesNoPreviousNextImportant Information: We do not include the cost of medications in the consultation price. *I am aware that even if my insurance does not cover a particular prescription, I will still need to pay for it at my local pharmacy.PreviousNextWhen was the last time you attended class or work? *PreviousNextDetails about your school or organization *PreviousNextPlease provide any other information that could assist us in determining the letter's medical necessity (optional).PreviousNextWhich way would you want to receive the letter? *Send a copy to my emailSend the letter to the business (such as the workplace or school) directly.Enter the contact information (name, email, phone, and fax) *PreviousNextWhen do you need this letter delivered electronically? *($64.99) Within the next THREE hours($54.99) By 11.30 pm CT today (Only if request submitted by 5 pm CT)($54.99) Next business dayPreviousNextImportant Disclosure *I am aware that after the medical letter has been sent to you, the consultation fee is non-refundable.I am aware that Reddydoc does not draft documentation for the FMLA, medical disability, permission to work remotely, or medical clearance following a serious injury.PreviousNextEligible Excused Days DisclosureI am aware that the note of excuse will only apply to today and future dates.I am aware that Reddydoc will not issue a note of justification that includes days the patient wasn't under its care.I am aware that Reddydoc can only grant an absence from work or school for a maximum of three days. (Day 1 begins now)PreviousNextWould you wish to provide the medical provider any images or supporting documents that are clinically relevant?YesNoPreviousNextUpload any photographs or medical records that support the claim. Click or drag a file to this area to upload. PreviousNextGiven the limitation of telemedicine, we encourage an in-person follow-up if your medical concerns do not resolve after a telemedicine visit. *I agree to follow-up for an in-person re-evaluation with a local doctor as neededI have an upcoming appointment with my doctorPreviousNextDo you have any further details you would like to present to the doctor today? (Optional)When is your next doctor's appointment? *PreviousNextSupplemental Service Disclosure *We prescribe FDA-approved medications and follow evidence based medical guidelines. In some cases, the initial medication may not completely eradicate your symptoms or cure the infection. In this situation, similar to other clinics and doctor's offices, the patient is responsible to pay for the follow-up visit and repeat treatment.I have been informed that it's my responsibility to handle prescription medication with care and store it in a safe environment. There's an additional fee to reissue lost or misplaced medications.I understand that there is a processing charge of $20 when a request is made for an excuse note or doctor's letterI understand that there's a $50 surcharge when a request for prior authorization or peer to peer review is required by your insurance or payerPreviousNextRefund Policy TermsI am aware that I have a full refund option at any point before ReddyDoc sends my prescription. Our consultation charge is no longer refundable once a medical professional has finished your treatment plan, submitted your prescription to your pharmacy, requested a test, or fulfilled your request.We aim to finish every consultation in under two hours. However, insufficient medical data, technical issues, or a high patient load may cause the turnaround time to be prolonged. Be prompt if you must cancel due to delays. If your request for a refund is made after we have sent your prescription to the pharmacy or finished the treatment plan, the consultation fee is NOT refundable.I am aware that the consultation cost is non-refundable in the event that my body does not respond to therapy or if the prescribed medicine does not entirely cure my disease or eliminate all of my symptoms. You are welcome to submit a second consultation for review.PreviousNextWould you wish to offer a Power of Attorney or an Emergency Contact? Yes, I want to add a power of attorney or an emergency contact.No! Please under no circumstances disclose my medical information to my relatives or friends.PreviousNextEnter the Full Name and Birthdate of the Emergency Contact (IMPORTANT). *PreviousNextDo you want to give the person who handles emergencies access to your medical records? *Yes! I hereby authorize ReddyDoc and its staff to provide my emergency contact with access to my medical records.No! I DO NOT authorize anyone to access my medical record or act on your behalf other than ReddyDoc, its designated agents, and employees.PreviousNextPharmacy Name *Pharmacy Address *Pharmacy Phone *PreviousNextBilling Address *Address Line 1Address Line 2CityState / Province / RegionAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePreviousNextConsultation feePrice: $54.99Stripe Credit Card *Submit