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Medical Certificate Notice - This online form is to be used by medical professionals only.
If you or a member of your household have a qualifying medical condition, your medical professional can submit the medical certificate to us online. For more information on medical certificates, please select your operating company from the left navigation and go to the Medical Needs Assistance section for more information. You can also email us or call our Customer Care Center for details on the information your medical professional will need to complete the medical form.
STEP 1 OF 4
Unique ID
Unique ID
Confirm Address
Required Info
Review & Submit
We appreciate your efforts to electronically complete the medical certificate for our customer. Please enter the Unique ID that you received from your patient below and click Next to continue.
If you are having issues with the Unique ID please call the Medical Certification department at (1-866-596-1783) with any questions.
