Request a Sick (Fit) Note Sick/Fit Note Request Name Date of Birth Day Month Year Contact NumberPostcode Postcode Please select the option that best describes your situation. I need a sick note for a new problem. I need a continuing sick note for an existing problem. You can self-certify for the first 7 days of illness. After this time, you need to speak with a GP to get a sick note for a new problem. Please make an appointment to discuss this further with a clinician.Please briefly describe the reason for the sick note. This is so that we can ensure this is a continuing sick note, and not for a new problem.Please select the option that best describes your situation. I am NOT currently able to work. I am able to work, but with some adjustments. (e.g. light duties) Please briefly describe any adjustments. (e.g. light duties) When should your sick note start from? DD slash MM slash YYYY Please note – your sick notes should not overlap. (e.g. if your last sick note ends on 05/12/2024, your new one can start from 06/12/2024)How long should your sick note last for?1 week (7 days)2 weeks (14 days)1 month6 weeks2 months3 monthsOtherThe maximum length is 3 months.Please enter how long your sick note should last. How do you wish to receive your sick note?Collect from ReceptionSend it to me via SMS
