Requesting an additional Sick 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 will contact you to let you know when you can collect your Sick Note or we may contact you to arrange an appointment.

Please allow 10 working days for your sick note to be processed.

You may wish to contact the surgery first to check if the sick note has been processed.

Sick Note Request

Sick Note Request

If you are human, leave this field blank.

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Phone Number:

Please let us know your preferred contact number in case we need to contact you.

Email Address: *

First date you were not at work due to this illness:

Please use this date format: DD/MM/YYYY.

Have you seen a doctor previously for this illness?

Describe your illness and why you need a Sick Note: