Sick / Fit Note Request with Intelligence
Is this your first sick / fit note for this illness?

First Sick / Fit Note

How long have you been ill (including holidays and weekends)?

If you have been sick for more than four days in a row, but less than seven, you can self–certify your illness using a SC2 form available online from HMRC.

Many employers have their own self-certification forms. You do not need to see a Doctor.

Requesting an additional Sick / Fit Note

If you have already had a Note for this illness your Doctor may not need to see you to issue an additional Note. Please complete this form. We will contact you to let you know when your Note is ready or we may contact you for more information.

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.

Doctor’s Sick / Fit 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 surgery may call you for more information.

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

Please complete the form below.

Your details

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

Your Illness

How would you like to receive your certificate? *

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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.

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