Sick/Fit Note

Sick/Fit Note request form

Please complete this form to tell us about your illness and we will direct you to the most appropriate form or service.

---

Sick / Fit Note Request with Intelligence

Is this your first sick / fit note for this illness?

Yes

No, I have already had a sick / fit note for this illness

First Sick / Fit Note

How long have you been ill (including holidays and weekends)?

7 days or less

More than 7 days

If you have been sick for more than four days in a row, but less than seven, you can self–certify your illness using a SC2 form available online from HMRC.

Many employers have their own self-certification forms. You do not need to see a Doctor.

Requesting an additional Sick / Fit Note

If you have already had a Note for this illness your Doctor may not need to see you to issue an additional Note. Please complete this form. We will contact you to let you know when your Note is ready or we may contact you for more information.

Doctor’s Sick / Fit Note for more than 7 days

If you have been ill for more than 7 days you will need a doctor’s certificate. These certificates are called ‘Fitness To Work’ Certificates.

Please call the surgery to arrange a consultation.

Your details

First Name *

Last Name *

Email *

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Your Illness

Start date for note *

End date for note *

What is the reason you cannot work? *

Describe your illness and why you need a Sick / Fit Note.

Privacy Policy

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. Please read our Privacy Policy to discover how we protect and manage your submitted data.

Your consent *

I consent to the practice collecting and storing my data from this form.

reCAPTCHA

Send

If you are off work due to a Hospital admission, a Sick Note can be issued by the Hospital to cover the period of time you were in the Hospital. Once discharged, your GP can issue a Sick Note, based on your Hospital discharge letter. If you think this is your situation, our Reception Team will assist you.

Please note a Sick or Fit Note can be backdated; please discuss this when you see your GP. Emergency or urgent appointments should not be used to request Sick / Fit notes.

Self-Certificate

If you have been sick for more than four days in a row, but less than seven, you can self–certify your illness using a SC2 form. You can obtain this form from your employer or the HMRC website. If you are unwell for more than four days you are advised to contact the surgery to assess your fitness to work.

More than seven days off sick

If you’re off work sick for more than seven days your employer will normally ask for a Fit Note (or Statement of Fitness for Work) from your GP or Hospital Doctor.

How to count sick days

When you work out the number of days that you’ve been sick, you need to count all the days in a row you’ve been sick, including days you don’t normally work such as weekends and bank holidays.

Statement of Fitness for Work

The Doctor will provide you with a Statement of Fitness for Work (‘Fit Note’) if you are still not well enough to work. Your employer will most likely request this statement as evidence to support payment of Statutory Sick Pay (SSP).

Further information is available at the Direct.Gov website.

When do I need a Fit Note?

The NHS Information website provides further details about Sick or Fit Notes.

Private Certificates

If you or your employer require further information concerning your period(s) of illness , then your Doctor may require to issue you with a letter. Please note that a charge may apply for this service. Please check with our Reception Desk.