Online Sick Leave L4

Fill out the form and receive a medical consultation to obtain a sick leave certificate.

  • In what cases is a sick leave certificate not issued:

    • When the start of the period of incapacity for work falls no more than 3 days back and 1 day forward from the date of issuance.
    • When the break between the issued L4 (regardless of the doctor who issued it) and the requested sick leave is less than 3 days (except for the extension of L4).
    • When the total number of days of incapacity for work exceeds 60 days in the last six months.
    • When after three attempts to establish telephone contact, the patient does not answer the phone, and the consultation does not take place, the E-Sick Leave will not be issued.
    • No possibility of refund! (Applies to the points mentioned above)

* Questions marked with a red asterisk must be answered.

Select employment

Select employment

  • Employee
  • Uniformed services worker
  • Student / Pupil
  • Employee in a foreign company

Previous medical records (optional):

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Patient Data

Phone