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.

The doctor may call you or arrange for an appointment.

If you have already been seen by your Doctor about this illness your certificate will be sent to you within a week.

Please Note – once you have submitted this information, any reply or acknowledgement from us will be sent to the email address you provide at top of the form. This response may include personal and sensitive information about you. We therefore strongly advise that you provide a personal email address that only you have access to. If you do not wish for us to communicate with you via email, please do not use this form and call us instead.

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:

Email Address: *

This email address will be used for all correspondence relating to this request. Please be aware that if anyone else has access to this email address that they may see responses sent to you.

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

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

Describe your illness and why you need a Sick Note: