Request a sick noteSick/Fit Note - v1.001InstagramThis field is for validation purposes and should be left unchanged.Is this your first sick/fit note for this illness?(Required) YES this is my first Sick/Fit Note for this illness NO this is not my first Sick/Fit Note for this illnessHow long have you been ill?(Required) I have been ill for 7 days or less I have been ill for more than 7 daysSelf-Certification sick/fit note for less than 7 daysIf you have been ill for 7 days or less you don’t need to see a doctor. You can complete a Self-Certification form yourself. However some employers insist on a doctor’s note regardless. A doctor’s note under these circumstances may involve a charge.Many employers have their own self-certification forms. If your employer doesn’t have its own form you can download the Self Certification Form. Please print it, fill it in and hand it in to your employer. You do not need to see a doctor.Download a self-certification form to give to your employerDoctor’s sick/fit note for more than 7 daysIf 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. If you have already been seen by your doctor about this illness your certificate will be sent to you within a week.Your full name(Required)Date of birth(Required) Day Month YearPhone number(Required)Email address(Required) Enter Email Confirm Email Date you would like your sick/fit note to start(Required) Day Month YearDate you would like your sick/fit note to finish(Required) Day Month YearDescribe your illness and why you need a sick/fit note(Required)Requesting an additional sick/fit noteIf you have already had a Sick Note (Fit Note) for this illness your Doctor may not need to see you to issue an additional Sick Note. Please complete this form. We will contact you to let you know when you can collect your Sick / Fit Note or we may contact you to arrange an appointment.Your full name(Required)Date of birth(Required) Day Month YearPhone numberEmail address(Required) Enter Email Confirm Email Date you would like your additional sick/fit note to start(Required) Day Month YearDate you would like your additional sick/fit note to finish(Required) Day Month YearDescribe your illness and why you need a sick/fit note(Required)Are there any reasonable adjustments your employer could make to help you return to work sooner?For example altered hours, working from home, amended duties, making workplace adaptations.Consent and termsThis form is for non-urgent enquiries and will take up to 7 working days for a response.Not for urgent medical help(Required) Yes, I understand this form is NOT for urgent medical helpConsent(Required)By submitting your details you are consenting to providing this information for improving our services to you. The data you supply on this form will be securely stored on our website, which is hosted by a third party. We will retain this information on the website for no longer than 7 calendar days. Your contact details will not be sold or shared with a third party. I understand I can revoke this consent at anytime by contacting the practice. Our privacy policy can be viewed on this website. I agree to the privacy policy.
