Requesting a Doctor’s Sick/Fit Note For More Than 7 days

Please use this form to request a sick/fit note once you have been off for more than 7 calendar days. If you already have a sick/fit note but require an extension/additional note please click here

Requesting a 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 are called 'fitness to work' certificates. The Doctor may call you or arrange for an appointment. If you have already been seen by or spoken to your Doctor about this illness your certificate will be sent to you within a week.
Full Name*
Date of Birth*
Mobile Phone Number*
Have you already self-certified for 7 days?*
Date you would like your sick/fit note to start*
DD slash MM slash YYYY
Date you would like your sick/fit note to end*
DD slash MM slash YYYY
Describe your illness and why you need a Sick/Fit note*
Consent*
I agree to the privacy policy.
Please note that no medical information or questions will be responded to. The data you supply on this form will be stored on our website, which is hosted by a third party, until it has been processed by the practice. The data will be used lawfully, in accordance with the Data Protection Act 2018, which gives you the right to know what information is held about you, and sets out rules to make sure that this information is handled properly. The practice privacy policy can be viewed on this website.

Requesting a Doctor’s Sick/Fit Note For More Than 7 days

Requesting a Sick/Fit note For More Than 7 days

Helpful links

Further Info

Phoenix Surgery