Since 15 January 2026, races run under the French Athletics Federation have stopped taking medical certificates from adult entrants. Paris-Versailles, an FFA-authorised road race, states it on its own entry page: "Le certificat médical n'est plus accepté", the medical certificate is no longer accepted. The document French races require from an unlicensed runner is the FFA's Pass Prévention Santé, an online module costing five euros. A British company still sells marathon medical certificates for sixty-nine pounds.
42cal's roster holds 559 marathons, and 518 of them publish a list of what a runner has to bring. Nineteen of France's twenty-one ask for a health document. Three of the 176 in the United States do. Chicago, London, Berlin, New York, Tokyo and Amsterdam want nothing beyond photo identification.
France and Italy supply thirty-six of the ninety races that ask for a health document, and what those two countries ask for in 2026 differs sharply from what the companies selling medical certificates describe.
France's Pass Prévention Santé replaced the doctor's note
On 2 March 2022 a new law rewrote Article L231-2 of France's Code du sport, and a medical certificate stopped being a legal requirement for an adult entering a competition. Issuing one became a federation's choice rather than a statutory duty. Parliament had removed the mandate, and the FFA then built its own instrument in its place.
The Parcours Prévention Santé arrived on 1 September 2024, a free online module covering risk situations, warning signs and first aid, and each completion was valid for three months. On 15 January 2026 the federation replaced it with the Pass Prévention Santé, which costs five euros and lasts a year. A runner completes it online before entering. Minors are outside it. They fill in a free health questionnaire before each race instead, which issues an attestation good for that race alone, and a certificate under six months old is needed only when an answer on that questionnaire is positive. That is the last place a doctor's note survives in French road racing.
For adults of every nationality, the FFA's running regulation lets a race accept two documents and nothing else: a current FFA racing licence, or a PPS issued within the year before race day. Foreign licences are refused outright, including those issued by a federation affiliated with World Athletics. Marathon du Médoc's official rules describe that requirement and offer no certificate alternative. A runner heading to the Paris Marathon needs the same pass, and 42cal's guide to Paris Marathon entry requirements covers the age minimum and the registration sequence in full. Whatever a certificate seller charges, French organisers will not take it.
In November 2025, before the charge took effect, the association France Outdoor asked the FFA to suspend the plan, citing serious legal weaknesses and warning that the cost would fall on small events and the occasional runners who enter them. A French senator put the same concern to the Ministry of Sport in a written question. The ministry replied that the fee sits within the FFA's public-service mandate.
Italy's certificate is real law, and most foreign runners skip it
Italy's rule predates almost every runner who now faces it. A 1982 government decree, Norme per la tutela sanitaria dell'attività sportiva agonistica, requires a fitness certificate for competitive sport, issued after a set protocol of exams. Non-competitive entry sits outside that decree entirely, which leaves a foreign runner with two routes.
A visitor who wants an official placing needs a Runcard, the entry licence Italy's athletics federation FIDAL issues to runners who belong to no club. A non-resident pays fifteen euros for one, it runs for 365 days, and the holder has to be at least twenty. It has to be paired with a sports-medicine certificate covering a fixed list of tests: a medical examination, a complete urinalysis, a resting and post-exertion electrocardiogram, and spirometry. An Italian insurer's guide to the cost of that exam puts it at sixty to a hundred euros, and the visit has to happen in person. It cannot be completed online, a detail most sellers of quick digital certificates leave out. Two further conditions catch visitors out. FIDAL requires the certificate to be issued for athletics specifically, so one written for another sport is refused, and Rome wants it uploaded at least ten days before the race.
Run Rome The Marathon lets a foreign citizen living abroad register as a non-competitive runner by accepting a disclaimer, with no certificate at all, and most foreign entrants take that route. Wizz Air Rome Half Marathon and Stramilano publish the same option. Rome states what that choice costs. The athlete "will be included in the results only with the race time without the position and without the category, and he will not be able to receive any prizes." Stramilano lists its non-competitive finishers in alphabetical order of arrival with their times, apart from the official ranking. A runner who takes the waiver covers the same course and finishes with a time and no placing.
FIDAL also removes a barrier most sellers advertise as a service worth paying for. The federation publishes its own certificate form in English and French, a document a runner's own doctor fills in, signs and stamps. No certified translation is required, because the form itself already carries the translation.
The online sellers describe a France that no longer exists
Where the data disagrees. Search "marathon medical certificate requirements" and the results are dominated by companies selling one. Fit Certify charges sixty-nine pounds for same-day issue and mentions France only in passing: "From 2024 onwards, some French running events like the Paris Marathon and Mont Blanc Marathon have replaced the medical certificate with a Health Prevention Course." A nationwide federation rule is more than some events, and the page still frames France as a market for the certificate it sells. One seller in those results gets it right. sportsmedicalcertificate.co.uk states that FFA events require the five-euro Pass Prévention Santé and that a doctor-signed certificate is not accepted instead, and that Italian competitive events require an in-person exam under the 1982 decree.
The FFA charges five euros for the document French races require. A visitor to an Italian competitive race pays fifteen euros for the Runcard plus sixty to a hundred for the exam behind it. A British GP practice that takes this work on privately charges sixty-five pounds for a report and a hundred and thirty-five with an examination, because it sits outside NHS-funded care. The sixty-nine-pound certificate sold online buys entry to neither country.
Most other countries ask only for photo identification
Outside France and Italy the pattern is patchier. Spain asks at 8 of its 15 marathons and Switzerland at 4 of 11, while Canada, the Netherlands and Ireland ask at none of theirs. A handful of races outside Europe carry versions of the same requirement. Hangzhou Marathon asks lottery winners for a medical report with blood pressure and an electrocardiogram before it lets them pay for their spot. Colombo's LSR Marathon requires a medical report with a resting twelve-lead ECG, submitted on registration day. Rosario's marathon in Argentina asks full-distance entrants for a certificado de aptitud física signed by a registered doctor, presented in person at kit collection.
Vienna, Linz, Malta and Sydney all appeared on 42cal as asking for a medical certificate until their own entry pages were read directly, and none of the four asks. Sydney's listing even carried a medical clearance for runners over 65 that appears nowhere in the race's rules. Second-hand listings go stale, including ours.
A runner who wants to know whether a specific race asks for anything should read that race's own current entry rules rather than a search result for the country's name. 42cal's country pages list every marathon by location, and a race's own registration page states the requirement that governs race day.
For a marathon in France, the answer is a five-euro pass completed online in advance. For a marathon in Italy, it is a choice between an in-person exam and a waiver that trades an official placing for a finish time. For nearly everywhere else, a passport or a national ID card is still the whole list.
Further reading
- FFA Pass Prévention Santé platform. The official page where the pass is completed, with its price and one-year validity stated directly.
- Code du sport, Article L231-2. The 2022 law that turned France's medical certificate from a legal duty into a federation's choice.
- FIDAL Norme Runcard 2025. Italian athletics' own rulebook, listing the exact exams a foreign certificate must include.
- Run Rome The Marathon official rules. The source for both Italian entry routes and what the non-competitive one costs a runner in the results.
- sportsmedicalcertificate.co.uk. The one ranking seller whose description of the 2026 French and Italian rules is accurate.
- FFA running regulation, applicable from 15 January 2026. Article 3.2 lists the only two documents a French race may accept from an adult of any nationality.
- Vittoria Assicurazioni's guide to Italian sports-medicine exam costs. The source for the sixty-to-a-hundred-euro range a competitive certificate costs in Italy.
