Requesting an extension to your Fitness to Work certificate

If you have already had a Fitness to Work certificate (Sick Note) for this illness your Doctor may not need to see you to issue an additional Fitness to Work certificate.

Please complete this form. The doctor may call you to clarify the information you provide 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

Section

If you require a sick note for less than 7 days

If you have been ill for 7 days or less you do not need a Fitness to Work Certificate (sick note) provided by the Doctor. You can complete a self certification form yourself.

Many employers have their own self-certification forms. If your employer doesn't have its own form you can download a Self Certification Form (PDF). Please print it, fill it in and hand it in to your employer. You do not need to see a Doctor.

Some employers insist on a Fitness to Work Certificate regardless. A Fitness to Work Certificate under these circumstances involves a charge of £17.95 for which the patient is liable if you want to request this, please complete a Medical Report Request.

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Your 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 ongoing? *
*