Sick / Fit Notes Request a Sick/Fit Note Step 1 of 2 50% Is this your first sick / fit note for this illness? Yes No, I have already had a sick / fit note for this illness You will need to call reception to request a first sick/fit note after you have self certified for 7 days. Requesting an additional Sick / Fit Note If you have been ill for more than 7 days you will need a doctor’s certificate. These certificates are called ‘Fitness To Work’ Certificates. If you have already had a Note for this illness your Doctor may not need to see you to issue an additional Note. Please complete this form. We will contact you to let you know when your Note is ready or we may contact you for more information.Your detailsName First Last Email Enter Email Confirm Email Date of Birth Day Month Year Contact NumberHow would you prefer to receive the note? Text Message Email Your IllnessStart date for fit note Day Month Year End date for fit note Day Month Year What is the reason you cannot work?Describe your illness and why you need a Sick / Fit Note.Privacy PolicyThis form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records. Please read our Privacy Policy to discover how we protect and manage your submitted data. I consent to the practice collecting and storing my data from this form.
