New Doctor’s Sick Note for more than 7 days

If you need a sick note, also known as a fit note, please read the guidance below before submitting your request.

If you have been ill for 7 days or less

If you have been ill for 7 days or less, you do not need to see a doctor. You can complete a self-certification form yourself.

Many employers have their own self-certification forms. If your employer does not have its own form, you can complete the self-certification form online.

Please print it, fill it in and give it to your employer.

Open the self-certification form

If you have been ill for more than 7 days

If you have been ill for more than 7 days, you will need a doctor’s certificate. These are called fit notes or fitness to work certificates.

The doctor may call you or arrange an appointment if this is needed.

Before you submit your request

Please complete all details on the form. If information is missing, your request may be rejected by the surgery.

It is important that you provide as much detail as possible so the GP can assess your request for a fit note.

About you

Full Name

Date you are completing this form?

Date of Birth

Phone Number

Email Address

SICK/FIT NOTE

What is your Job?

What is preventing you from working?

Have you sought any help to return back to work?

FIRST DATE YOU WERE NOT AT WORK DUE TO THIS ILLNESS

What date does your sick/fit note need to start?

How long do you anticipate you will need it to be? (select date).

TOTAL NUMBER OF DAYS YOU WERE ILL?

DESCRIBE YOUR ILLNESS AND WHY YOU NEED A SICK / FIT NOTE

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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