Sick (fit) note request

If this is a new illness, have you completed a self certification note (it will cover the first 7 days of your illness)? *

Yes

No

Not applicable

Please visit Self Certification Sick/Fit Note for less than 7 days to download a self certication form.

What is the reason you require a Sick / Fit note? *

Do you require: *

A sick note i.e. you cannot work currently

A fit note note (you may be able to work but with limitations such as altered duties or reduced hours etc)

Please give details of what you would like your note to cover:

When did your self certification note or previous sick note end? *

Please do not request your sicknote until the day after your last note expires as the doctor may reject your request if you request your note too early.

How long do you feel you require this note to last? *

The GP will review your request. The GP may alter some of the details or may need to contact you to clarify certain details. The sicknote will be emailed to you once completed.

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