Request Fit Note

Sick / Fit Note Request with Intelligence
Are you self-isolating because you, or someone you live with, has symptoms of coronavirus?

Isolation Note from 111

Please check the NHS guidance on self-isolating here www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/.

You can get an isolation note from 111 online to give to your employer. You do not need a sick note from the surgery.

Is this your first Sick Note for this period of illness?

First Sick / Fit Note

How long have you been ill (including holidays and weekends)?
As you have been ill for 7 days or less you don’t need to see a Doctor. You can complete a Self Certification form.
Arrange a consultation
As this is your first Sick Note and you have been ill for more than seven days we would like you to speak with one of our doctors. Please arrange a telephone consultation via online services or by calling the surgery.
As you have already had sick note for this illness, you may not need to see your Doctor to receive a subsequent Sick Note.

Please fill in the form below and contact the Surgery after 3 working days. Please note Notes cannot be postdated

Your details

Please use format day/month/year e.g. 12/05/1979

Your Illness

You should specify your full period of illness including weekends and holidays, not just days off work.
Describe your illness and why you need a Sick / Fit Note.

Privacy Policy

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. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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