Sick (fit) note request

Use this service to get a sick (fit) note for work following an absence of more than 7 days.

You can use this service if you:

Before you start

We’ll ask you for:

your first and last name, date of birth, sex, postcode, email and phone number
if applicable, the details of the person you are completing the form on behalf of

Online form

What is your first name?

What is your last name?

Date of birth

Your gender

Male

Female

Other

Your address:

Street Address Optional Address Line 2 Optional City Optional ZIP / Postal Code Optional

Email address

Start date of sick / fit note:

End date for sick / fit note: *

Describe your illness and why you need a sick / fit note:

Are you happy for us to send you your sick/fit note digitally? *

Yes