Fit Note Extension Request

 

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Fit (Sick) Note
 

If you have been ill for 7 days or less you don’t need to see a Doctor. You can complete a Self Certification form yourself. However some employers insist on a Doctor’s note regardless. A Doctors note under these circumstances may involve a charge. Many employers have their own self-certification forms. If your employer doesn’t have its own form you can complete the Employee's Statement of Sickness (SC2) form online. 

When you’ve filled in the form give it to your employer, it will help them decide if you can get SSP. Keep a copy for your own information.

As this is a new request for a Fit Note, you will need to speak to a clinician before a sick note can be issued. Please phone the practice to arrange an appointment (telephone or face to face), or you can complete an e-Consult.

E.g. could you work from home, do fewer hours, or do different tasks at work?
 
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Personal Details

Please provide your details to help us find your record. If you are filling this in on behalf of someone else, please enter their details.

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May be used to identify you
 
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Confirmation

Please confirm your details are correct

Date of Birth:

Gender:

Phone Number:

 

Query: Fit (Sick) Note

Have you already had a note about this?

Tell us briefly about your illness or medical problem

When would you like the note to start? When do you think you can return to work?

If possible, is there anything your employer could do to help you return sooner?

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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