Fitness to Work Request / 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 to clarify the information you provide on this form, and in some circumstances arrange for you to be seen.

Unless you hear otherwise, you can collect your Fitness to Work certificate from our reception desk after three working days.

You must be registered with this practice to submit this form. 

Fitness to Work Request

Fitness to Work Request

Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.
Include holidays and weekends, not just days off work.
Is the condition still on-going?
*