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
A maternity exemption certificate entitles you for:
- free NHS dental treatment
- free NHS prescriptions, if you have a valid maternity exemption certificate
Patients must be 20 weeks pregnant or have given birth in the last 12 months
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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This form was created inside of west green surgery.