S
SickSlip
Start my visit

Did Amazon DLS ask for a Health Care Provider Form?
We’ll complete it today.

A board-certified MD evaluates your symptoms, then prepares Amazon’s E103 + E117 forms — same shift. Save your UPT, keep your points clean.No HR or DLS forms to upload — we have them.

Start my visit
$39 | includes E103 + E117 forms | Refund if not approved
Physician online now
What you get for $39

Three documents, DLS-ready

All three arrive in one email. You don’t need to upload anything from AtoZ— we already have Amazon’s forms.

SickSlip Note
Physician-signed doctor's note
Amazon E103 sample
Amazon E103
Health Care Provider Form (signed)
Amazon E117 sample
Amazon E117
Authorization to Disclose Information
Why $39?

You get 3x the work for $9 more.

A standard SickSlip note is $29.99. The Amazon DLS service is $39 because we also generate and sign the E103 Health Care Provider Form and prepare the E117 Authorization — both completed by Dr. Kawalek, no upload needed.

Compare to a traditional clinic: ~$60 per form, 7–10 day wait, requires an existing patient relationship. By the time the form is filled, your UPT bucket is empty and ADAPT has already added the points. We do all of it same-shift for less.

Used by employees at
FedEx.UberWalgreensTARGETStarbucksAT&TamazonCOSTCODeltaCVSKrogerFedEx.UberWalgreensTARGETStarbucksAT&TamazonCOSTCODeltaCVSKroger
Your Physician Today
Dr. Adam Z. Kawalek, MD
Board-Certified · 15+ years experience
NPI 1326223306 · LICENSED IN 30+ STATES
Online Now
How it works

Three simple steps

1
Tell us about your call-out
Short health intake: your symptoms, dates affected, and your Amazon job title (Fulfillment / Sortation / Delivery Associate, etc.). We complete the DLS Health Care Provider Form — you don’t need to download anything from AtoZ first.
2
A real MD reviews
Dr. Adam Z. Kawalek personally evaluates your case and signs the completed E103 under his medical license. Section A2 marked as company-leave-options absence (not FMLA) — the honest fill DLS credits without escalation.
3
Forms go to your inbox, ready for DLS
You receive the SickSlip note, the signed E103, and the E117 release in one email. Submit through AtoZ MyHR, fax to 1-855-579-1799, or email amazondls@amazon.com. UPT preserved, no points added.
What’s included

Every SickSlip note includes

Completed E103 DLS form
Sections A–D filled in by a licensed physician — prepared from your intake, no upload required
Standard SickSlip note
Separate physician-signed note for your records, with QR-verifiable physician credentials
Same-day turnaround
Most forms returned within hours — beats the 7–10 day clinic wait
Submission to DLS
Optional: we fax the completed form to 1-855-579-1799 directly so DLS receives it on your behalf
E117 release (on request)
Authorization for DLS / WorkCare to contact us back with follow-up — available if your case manager asks for it
HIPAA compliant
Encrypted intake, encrypted storage, BAA-covered subprocessors
What patients say

Honest words from real patients

Came down with strep mid-shift and burned through my last UPT just getting home. Missing another day without documentation would've put me over the points line. SickSlip got me a real physician note plus the E103 the same evening. DLS accepted everything the next morning.

Sarah M.
Austin, TX (AUS2)

My PA told me I needed something on file from a doctor since this was my second call-out in the rolling window. The note came back signed by a board-certified physician — NPI and state license printed right on it. WorkCare accepted the bundle without any follow-up.

Michael R.
Miami, FL (MIA1)

Brutal migraine on a 4×10 day — no way I was going to make rate. The doctor's review actually felt thorough, not a template. The E103 went through ADAPT with no kickback from DLS. Taking off one star because the symptom list didn't have my exact migraine variation but I found the closest match.

Jessica L.
Phoenix, AZ (PHX7)

Stomach bug hit on a Sunday — couldn't keep water down let alone make it to the building. Submitted the intake from my couch, had the SickSlip note plus DLS forms in my inbox before the morning standup. UPT preserved, zero points added.

David K.
Atlanta, GA (ATL6)

Caught the flu during peak season and DLS sent me the E103 the same day I called out. A coworker mentioned SickSlip. Got the form back signed by a real MD with the right wording — "acute illness, not FMLA-qualifying" which is what DLS needs to credit it as company leave. Cleared in 24 hours.

Maria T.
Dallas, TX (DFW7)
Frequently asked

Common questions

No. We have Amazon's E103 (Health Care Provider Form) and E117 (Authorization to Disclose Information) ready to go. You answer a short health intake and tell us your job title; we complete both forms from your information.

DLS form due back?
A doctor can complete it now

Tell us your symptoms and your Amazon job title. We’ll prepare the E103, signed by a board-certified MD, before your next shift starts. No AtoZ upload, no points.

Start my visit
$39 | includes E103 + E117 forms | Refund if not approved
HIPAANPI Verified30+ States
S
SickSlip
© 2026 SickSlip, Inc. · (877) 861-4165
Terms·Privacy·HIPAA
SickSlip is an independent medical practice. We are not affiliated with, endorsed by, or sponsored by Amazon.com, Inc. or any of its subsidiaries. “Amazon” and “A to Z” are trademarks of Amazon.com, Inc. References to Amazon’s leave forms (E103, E117) are descriptive of the documents Amazon distributes to its employees for completion by an independent licensed physician.
Start my visit· $39
S
SickSlip
Start my visit
Physician online now

Did Amazon DLS ask for a Health Care Provider Form?
We’ll complete it today.

A board-certified MD evaluates your symptoms, then prepares Amazon’s E103 + E117 forms — same shift. Save your UPT, keep your points clean.No HR or DLS forms to upload — we have them.

Start my visit
$39 | includes E103 + E117 forms | Refund if not approved
Adam Z. Kawalek, MD
Board-Certified, Internal Medicine
NPI 1326223306
DEA: ABCD12345
[State] Medical License A-123456
 
Scan to verify
Physician Statement of Medical Absence
April 6, 2026REF SS-2026-04A-7F3B9
To whom it may concern,

This letter confirms that [Patient Name] was evaluated by the undersigned physician and was medically unable to attend work or school from April 2, 2026 through April 4, 2026. This determination is issued for documentation purposes based on information provided at the time of review. In accordance with HIPAA, no diagnosis or clinical details are included.

The patient is cleared to return on April 6, 2026. Should you require verification, please scan the QR code above or contact our office at the number listed below.
Adam Z. Kawalek, MD · Board-Certified Internal Medicine
Electronically signed · 2026-04-06 16:42:07 UTC · SHA-256: 7f3b9a2e…c41d
CONFIDENTIAL · This document contains protected health information and is intended solely for the recipient identified above. Unauthorized access, use, disclosure, or distribution is prohibited under 45 CFR § 164 (HIPAA Privacy Rule).
ID: SS-C9SDESES3WS(877) 861-4165 · support@sickslip.co
Representational image
What you get for $39

Three documents, DLS-ready

All three arrive in one email. You don’t need to upload anything from AtoZ— we already have Amazon’s forms. Just sign the E117 by hand before you submit to DLS.

SickSlip Note
Physician-signed doctor's note
Amazon E103 sample
Amazon E103
Health Care Provider Form (signed)
Amazon E117 sample
Amazon E117
Authorization to Disclose Information
Why $39?

You get 3x the work for $9 more.

A standard SickSlip note is $29.99. The Amazon DLS service is $39 because we also generate and sign the E103 Health Care Provider Form and prepare the E117 Authorization — both completed by Dr. Kawalek, no upload needed.

Compare to a traditional clinic: ~$60 per form, 7–10 day wait, requires an existing patient relationship. By the time the form is filled, your UPT bucket is empty and ADAPT has already added the points. We do all of it same-shift for less.

Used by employees at
FedEx.UberWalgreensTARGETStarbucksAT&TamazonCOSTCODeltaCVSKrogerFedEx.UberWalgreensTARGETStarbucksAT&TamazonCOSTCODeltaCVSKroger
Your Physician Today
Dr. Adam Z. Kawalek, MD
Board-Certified  ·  15+ years of clinical experience
NPI 1326223306  ·  LICENSED IN 30+ STATES
Online Now
How it works

Three simple steps

1
Tell us what's going on
Complete a short health intake — your symptoms and the dates affected.
2
A real MD reviews
A licensed physician personally evaluates your symptoms and makes a clinical determination.
3
Receive your note
If approved, your signed note arrives by email with a QR code for employer verification.
What’s included

Every SickSlip note includes

Completed E103 DLS form
Sections A–D filled in by a licensed physician — prepared from your intake, no upload required
Standard SickSlip note
Separate physician-signed note for your records, with QR-verifiable physician credentials
Same-day turnaround
Most forms returned within hours — beats the 7–10 day clinic wait
Submission to DLS
Optional: we fax the completed form to 1-855-579-1799 directly so DLS receives it on your behalf
E117 release (on request)
Authorization for DLS / WorkCare to contact us back with follow-up — available if your case manager asks for it
HIPAA compliant
Encrypted intake, encrypted storage, BAA-covered subprocessors
What patients say

Honest words from real patients.

Came down with strep mid-shift and burned through my last UPT just getting home. Missing another day without documentation would've put me over the points line. SickSlip got me a real physician note plus the E103 the same evening. DLS accepted everything the next morning.

Sarah M.
Austin, TX (AUS2)

My PA told me I needed something on file from a doctor since this was my second call-out in the rolling window. The note came back signed by a board-certified physician — NPI and state license printed right on it. WorkCare accepted the bundle without any follow-up.

Michael R.
Miami, FL (MIA1)

Brutal migraine on a 4×10 day — no way I was going to make rate. The doctor's review actually felt thorough, not a template. The E103 went through ADAPT with no kickback from DLS. Taking off one star because the symptom list didn't have my exact migraine variation but I found the closest match.

Jessica L.
Phoenix, AZ (PHX7)
Frequently asked

Common questions

No. We have Amazon's E103 (Health Care Provider Form) and E117 (Authorization to Disclose Information) ready to go. You answer a short health intake and tell us your job title; we complete both forms from your information.

DLS form due back?
A doctor can complete it now

Tell us your symptoms and your Amazon job title. We prepare and sign the E103, sign it, and have it ready to submit to DLS before your next shift starts. No AtoZ upload, no points.

$39 | includes E103 + E117 forms | Refund if not approved
HIPAANPI Verified30+ States