New Sick Note Request

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.

We cannot forward date sicklines, however, we can backdate them.

New Sicknote Request

Please fill out this form to request a Sicknote for a NEW episode of illness.

If you have had a previous sicknote for the same illness then please fill out the Sicknote Extension form.
As this is a Sicknote for a new illness we may call you to discuss this.

If you have been sick for fewer than seven days in a row, you can self-certify your illness using the online HMRC Form. Many employers have their own self-certification forms. You do not need to see a Doctor.

How long have you been ill (including weekends) *

7 days or fewer

> 7 days

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

Yes No

Your Details

Full Name *

Occupation *

Date of Birth *

Phone Number *

Email Address *

Sick/Fit Note

What date would you like your sick note to start? (This must be no earlier than day 8 of continuous absence) *

TOTAL NUMBER OF DAYS YOU WERE ILL OR IS STILL ONGOING *

When you hope to return to work? *

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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Page last reviewed: 26 June 2026
Page created: 27 May 2026

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New Sick Note Request

New Sick Note Request

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