I understood your concern  and noted the problem as well .I need to ask few more details to make a diagnosis and start treatment and advice which suits you. Pl consult me on Practo , so that I can help you better.book a time slot as per your convenience for consultation.

you are definitely going to get your doctor jailed..please donot fill this on your own

Kindly discuss for your concern

Please visit some local general physician

Go visit a  registered medical professional physically. How will you get it signed.

Hello, where did u get the height, weight, vision n BP checked? The other areas left blank need to be examined. How will u get the doctor's signature on it?

Please appreciate that no medical certificates can be given by Tele-consultation. We don't know who you are, whether alive or dead . We don't know for what purpose this certificate is going to be used. Suppose it pertains to a person who is dead and some legal proceedings are going on against some persons (on charges of murder) in some Court , and suddenly this certificate comes up. Can you imagine what will happen to that Doctor ?