Requesting an additional Sick / Fit Note

If you have already had a Sick Note (Fit Note) for this illness your Doctor may not need to see you to issue an additional Sick Note. Please complete this form. We will contact you to let you know when you can collect your Sick / Fit Note or we may contact you to arrange an appointment.

Please be aware, that if you submit a form outside of working hours, it will not be viewed until the next working day.

Sick / Fit Note Request

If you are human, leave this field blank.

How would you prefer to receive your note? *

Send note as a file attached to a text message

Send in an online message

Collect at the practice

First date of sick note required: *

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

End date of sick note required: *

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

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

Please specify your current or past occupation:

Why are you unable to work?

Is there any type of work you could still do with your current illness? Would you benefit from a note stating reduced hours/amended duties/phased return to work?

I confirm the information provided is correct and that it will be used by the GP to review my request

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Sick / Fit Note Request

Research Unit