Fit-to-fly certificates in Bali: who actually needs one
A surfer at the check-in desk with a fresh cast on his wrist. A diver who logged four dives yesterday and wants to fly home tonight. A traveller who is 36 weeks pregnant and has just discovered her airline has opinions about that. All three are asking the same question: do I need a doctor's letter to board? Most travellers never do. This guide covers when airlines ask, what the letter has to say, and how to get one in Bali without leaving your villa.
The short answer
Most travellers never need a fit-to-fly certificate. Airlines ask for one after recent surgery or a hospital stay, from 28 weeks of pregnancy, after a diving incident, or when you look unwell or injured at the gate. In Bali, a licensed doctor can assess you by video and issue a signed fit-to-fly PDF, usually the same day. A few cases need a physical exam, which is arranged and confirmed upfront. Your first GP consultation is free.
Talk to a doctor about your certificate
Who gets asked for a fit-to-fly certificate?
Airlines rarely question a healthy passenger. Check-in staff are not doctors and have no wish to be; what they have is a clause in the conditions of carriage that lets them refuse boarding to anyone who appears unfit to travel. A fit-to-fly certificate exists to settle that question before it gets asked at the gate.
In practice, requests cluster around a few situations:
- A visible cast, sling, bandage or wheelchair at check-in
- You booked special assistance and disclosed a medical condition
- Surgery or a hospital admission in the days before the flight
- Pregnancy from 28 weeks
- An illness people can see. Chickenpox is the classic: airlines generally want every spot crusted over before you board, which typically takes 5 to 7 days from when the rash appears
- A previous flight that was diverted or disrupted because of your condition
The Bali versions walk through our door every week: scooter fractures in fresh casts, travellers a few days out of hospital after dengue, surfers with sutures still in. None of these automatically stop you flying. They do mean the airline may want a doctor's signature saying you're safe to be at 38,000 feet for the next seven hours.
What is a MEDIF form, and when does an airline want one?
MEDIF is short for Medical Information Form, an IATA-standard form that most airlines base their medical clearance process on. It has two parts: one you complete yourself, one your treating doctor completes, and the airline's medical department reviews both before approving you for the flight.
Airlines reach for it when the situation goes beyond a simple letter: oxygen on board, stretcher transport, a recent serious or unstable condition, anything ground staff can't judge from a one-page certificate.
Deadlines are the trap. Most airlines want the completed form at least 48 to 72 hours before departure, some want a week, and each airline has its own version with its own quirks. So the order of operations matters: download your airline's form first, then book the consultation. A Bali Doc doctor can complete the physician section after assessing you, ideally with your discharge summary or recent results on the screen in front of them.
How long after diving can you fly?
Aircraft cabins are pressurised to the equivalent of roughly 6,000 to 8,000 feet, not to sea level. After diving, your tissues still hold dissolved nitrogen, and the pressure drop at cruising altitude can pull it out of solution as bubbles. That is decompression sickness, arriving at the precise moment you are furthest from a hyperbaric chamber.
The Divers Alert Network guidance is specific, and worth following to the letter:
- At least 12 hours after a single no-decompression dive
- At least 18 hours after multiple dives in a day, or multiple days of diving
- Substantially longer than 18 hours after any dive that required decompression stops
A certificate cannot shorten those windows, and a doctor who offers to sign one that does is not doing you a favour. What a doctor can do is help you plan: count back from your departure time, fix your last dive day, and, if you have had any symptoms after diving, work out whether you need a dive physician before you fly at all. Anyone treated for decompression sickness needs a dive medicine specialist to sign them off before boarding.
A different document gets confused with this one: the pre-dive medical that Bali dive operators ask for before courses and some guided diving. That one looks forward (are you fit to dive), not backward (are you fit to fly after diving), and it more often needs a physical exam. Both are handled through our medical certificates service.
How many weeks pregnant can you fly?
Up to about 28 weeks, most airlines let you fly without any paperwork. From 28 weeks, most want a recent letter from a doctor or midwife confirming your due date, whether you are carrying one baby or more, and that there are no complications. Carriage usually ends around 36 weeks for a single baby and around 32 weeks for uncomplicated twins.
The detail that catches people out is freshness. The letter usually has to be dated close to the flight, often within 7 to 14 days, so a letter written by your obstetrician at home before a two-month trip may have expired by the time you fly back. That is the most common pregnancy request we see in Bali: a fresh letter, close to the departure date, for the flight home.
When the pregnancy has been routine and you have your antenatal records or scan results to show the doctor, this works well by video and the letter is usually issued the same day. If anything needs checking in person, the doctor says so and an examination is arranged first. Cutoffs and letter requirements differ between airlines, sometimes by several weeks, so read your airline's conditions of carriage before you rely on the pattern above.
How soon can you fly after surgery, a fracture or a blood clot?
The physics first: at cabin altitude, gas trapped anywhere in the body expands by roughly 30 percent. Air left inside the abdomen or chest after an operation stretches as the aircraft climbs, and stretching fresh surgical sites is exactly what you don't want.
UK Civil Aviation Authority passenger guidance, widely used as the benchmark, runs roughly like this: around 10 days after abdominal or chest surgery, as little as a day or a few days after a simple laparoscopic procedure, and after eye surgery involving an intraocular gas bubble, no flying at all until the surgeon confirms the bubble has gone, which can take weeks depending on the gas used.
Fractures bring their own rule. Many airlines require a plaster cast fitted within the previous 24 to 48 hours to be split along its length before you board, because a limb can swell at altitude and a rigid cast doesn't stretch. Splitting is a quick job for a clinic, and far better arranged the day before than argued about at check-in.
A collapsed lung and blood clots sit at the serious end. After a pneumothorax, standard advice is not to fly until imaging confirms the lung has fully re-expanded, and commonly to wait a further one to two weeks after that. After a deep vein thrombosis or pulmonary embolism, flying is usually delayed until blood-thinning treatment is established and symptoms are settling, often a few weeks. Both are specialist decisions made on your scans and your history, not on a table in an article, including this one.
That variability is what the certificate is for. It replaces a general rule with a doctor's judgement about you, on a specific date, in writing.
What if you're too sick to fly?
Sometimes the question runs the other way: you have a ticket, and you are in no state to use it.
The document you need then is an unfit-to-fly certificate, and its main audience is your travel insurer. Before reimbursing a changed or cancelled flight, insurers generally want a doctor's certificate stating that you were unfit to fly, with the diagnosis and the dates. The Bali regulars: dengue while the platelet count is low (our dengue fever guide explains why days 4 to 6 are the ones to watch), severe Bali Belly with dehydration, and middle-ear infections that turn descent into an ordeal.
A note that satisfies a claims team covers the diagnosis, the dates you were assessed and considered unfit, a plain statement that you were unfit to fly, and the doctor's signature, stamp and STR licence number, which is the part the insurer verifies.
Timing decides whether the claim succeeds. See a doctor while you are still ill, on the day you decide not to fly if you can. A certificate documents what the doctor found at the assessment; it cannot be backdated to cover last week's fever, and a doctor willing to backdate one would be issuing paper your insurer has every reason to distrust. That rule occasionally disappoints people, and it protects the value of every certificate that is issued properly.
Message us with your situation and travel dates. A doctor can assess you by video today and, where clinically justified, issue the certificate your airline or insurer needs.
How does a fit-to-fly assessment work in Bali?
The doctor can only certify what can be clinically confirmed. Everything else about the process follows from that.
You book a video consultation (the first GP consultation is free) or message us on WhatsApp with what you need and when you fly. The doctor asks about the diagnosis, the dates and how you are now, and will want to see whatever paper exists: a discharge summary, an X-ray report, recent blood results, your antenatal card. Photos of a wound or a rash help more than people expect.
Most certificates can be issued after the video assessment: a signed PDF carrying your name, your passport number if the airline requires it, a clear fitness statement, the date of the assessment, and the doctor's signature and STR licence number. It usually lands in your inbox the same day, often within hours. Where a physical examination is needed, for a dive clearance or a chest that should be listened to, the doctor says so and we arrange a home visit or an in-person check, with the price confirmed before you commit to anything.
The doctor certifies what can be confirmed on the day, so a certificate is never a workaround for a dive table or a surgical waiting period. And the airline keeps the final say at the gate; a truthful, specific certificate is the standard way to answer their question before it gets asked, and it is exactly the kind of paperwork gate staff and airline medical desks are used to accepting.
The practical version
Check your airline's rules the day something happens, not the day you fly. The conditions of carriage on its website answer most of this in five minutes, including whether a plain letter is enough or a MEDIF form is needed.
Count backwards. Dive surface intervals, surgical waiting periods and pregnancy letter windows all run on dates, so fix your last dive day and your consultation date as soon as the flight is booked.
Get assessed while the situation is live. Fit or unfit, the certificate can only describe the day of the assessment, and that is precisely what makes it worth something to an airline or an insurer.
And if you are not sure whether you need one at all, ask. Answering that question costs nothing, and the first GP consultation is free.
General information, not medical advice. Whether you are fit to fly is an individual clinical decision made by a licensed doctor, and your airline's own rules always apply.
Frequently asked
How fast can I get a fit-to-fly certificate in Bali?
Usually the same day, once the doctor has what they need. A morning video consultation, with your discharge summary or test results to hand, often means a signed PDF by the afternoon. If a physical exam is needed, or your airline wants its own clearance form completed, allow an extra day. Certificates document the day of assessment, so start before your flight, not after it.
Can I get a fit-to-fly certificate fully online?
For most situations, yes. The doctor assesses you by video, may ask for recent records or test results, and issues a signed PDF. Some cases need an in-person check, for example a chest that should be listened to after a lung problem. The doctor will say so, a home visit or clinic check is arranged, and everything is confirmed before you pay.
Can I fly with dengue?
Sometimes, and it depends mostly on your platelet count and how your recovery is going. Platelets tend to fall between days 4 and 6 of the illness, which is a bad window to spend at cruising altitude far from a hospital. A doctor will usually want a recent blood count before certifying you fit, and if the numbers are low the safer call is an unfit-to-fly note and a rebooked flight, which your insurer will want documented anyway. Our dengue fever guide covers the illness itself in detail.
How many weeks pregnant can you fly?
Most airlines carry an uncomplicated single pregnancy up to around 36 weeks and uncomplicated twins to around 32, and from 28 weeks they want a recent letter from a doctor or midwife confirming your due date and that all is well. The letter usually has to be dated close to the flight, often within 7 to 14 days. Every airline sets its own cutoffs, so read your airline's conditions of carriage rather than relying on any general rule, including this one.
How long after scuba diving can you fly?
Divers Alert Network guidance: wait at least 12 hours after a single no-decompression dive, at least 18 hours after multiple dives in a day or multiple days of diving, and substantially longer than 18 hours after any dive that needed decompression stops. The waits exist because leftover nitrogen in your tissues can form bubbles at cabin altitude, and no certificate can shorten them.
Can I get an unfit-to-fly certificate for a travel insurance claim?
Yes. Insurers generally want a doctor's certificate stating that you were unfit to fly, with the diagnosis, the relevant dates, the doctor's stamp and their STR licence number. Timing matters most: get assessed while you are still ill, because a certificate records what the doctor found on the day of the assessment and cannot be backdated to cover last week's fever.
