Doctor’s Sick/Fit Note

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. Please note that doctors cannot future-date a certificate.

If you are ill for less than 7 days, you do not need a doctor's certificate. Please speak to your employer about how to self-certificate.

Last Updated: 30/03/2023

Your Details

Full Name *

Date of Birth *

Phone Number

Email Address *

Sick/Fit Note Details

Is this an extension of a previous sick/fit note? *

Yes No

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

Total number of days the sick/fit note needs to cover *

Please describe your illness or condition 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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Doctor’s Sick/Fit Note

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