Requesting an additional Sick / Fit Note

If 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 are unable to issue sick notes in advance, please ensure you clearly detail the date your certificate ends so that we can schedule the new issue appropriately

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.

Last Updated: 18/11/2024

Sick/Fit Note Request

Full Name *

Date of Birth *

Address *

Phone Number *

Email Address *

Additional Sick/Fit Not Request

Please acknowledge you are requesting a continuation of an existing sick note *

Yes No

What date does your previous sick note end? *

Tell us briefly about your illness or medical problem *

When do you think you can return to work? *

If possible, is there anything your employer could do to help you return sooner? *

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.

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Requesting an additional Sick / Fit Note

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