Maternity Exemption Certificate (MatB1)
Please use this form if you are requesting for a certificate for maternity exemption certificate. Patients must be 20 weeks pregnant or given birth in the last 12 months
Entitlement
A maternity exemption certificate entitles you for:

- free NHS dental treatment
- free NHS prescriptions, if you have a valid maternity exemption certificate
Criteria
Patients must be 20 weeks pregnant or have given birth in the last 12 months
YOUR DETAILS
Please include your latest personal details so that we can contact you if necessary
Your Full Name *
Your Date of Birth *
Please include your DOB in the form of DD/MM/YYYY i.e 01/01/1980
Your MOBILE number *
If we need to contact you to clarify your answers especially if your asthma is poorly controlled
Your EMAIL address *
MATERNITY EXEMPTION CERTIFICATE REQUEST
Are you pregnant? *
What type of sick note do you require a letter for absence of work or a note stating
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