Doctor’s Sick Note for more than 7 days

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. If you have already been seen by your Doctor about this illness your certificate will be sent to you within a week.

Please know that we do not give out fit note, if you feel ready to go to work then you can go to work.

Last Updated: 19/12/2024

Your Details

Full Name *

NHS NUMBER *

Date of Birth *

Your Mobile Phone Number (Your sick note , if approved will be sent via a SMS message to this mobile number)) *

Email Address

DOES THE PATIENT CONSENT TO RECEIVE SMS/EMAIL ALERTS? *

Yes

Sick/Fit Note

Is this a new request or an extension? *

New Request

Extension

FIRST DATE OF THE SICK NOTE (IF EXTENSION, PUT IF FROM THE DAY AFTER YOUR PREVIOUS SICK NOTE RAN OUT, IF NEW SICK NOTE, PUT THE DATE AFTER YOU FINISHED YOUR 7 DAYS SELF-CERTIFICATION) *

DATE THAT YOU WANT YOUR SICK NOTE TO BE EXTENDED TO? *

TOTAL NUMBER OF DAYS YOU WERE ILL OR IS STILL ONGOING

DESCRIBE YOUR ILLNESS AND WHY YOU NEED A SICK NOTE (PLEASE INCLUDE IF YOU NEED TO SHOW IT TO THE JOB CENTRE) *

HAVE YOU BEEN RECENTLY DISCHARGED FROM HOSPITAL OR HAD A CLINICAL ASSESSMENT RESULTING IN YOU NOT BEING ABLE TO WORK? *

Yes No

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Doctor’s Sick Note for more than 7 days

Further Information