Request a Doctor’s Sick/Fit Note for more than 7 days

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. The doctor may call you or arrange for an appointment. You can only be use this service if you have spoken to or seen a doctor regarding this condition.

Your Details

Full Name *

Date of Birth *

Phone Number *

Email Address *

Sick/Fit Note

FIRST DATE YOU WERE NOT AT WORK DUE TO THIS ILLNESS *

THE DATE YOU REQUIRE THE FIT NOTE TO START (FROM DATE) *

THE DATE YOU REQUIRE THE FIT NOTE TO RUN UNTIL (END DATE) *

TOTAL NUMBER OF DAYS YOU WERE ILL OR IS STILL ONGOING *

DESCRIBE YOUR ILLNESS AND WHY YOU NEED A SICK / FIT NOTE *

I confirm that I spoken to or seen a GP regarding this condition *

Yes No

This 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 held by the practice and our partners in the NHS. 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.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Page last reviewed: 25 November 2024
Page created: 25 October 2022

Request a Doctor’s Sick/Fit Note for more than 7 days

Request a Doctor’s Sick/Fit Note for more than 7 days

Further Information