Requesting an additional Sick / Fit Note

If you have already had a Sick Note (Fit Note) for this illness your Doctor may not need to see you to issue an additional Sick Note. Please complete this form. We will contact you to let you know when you can collect your Sick / Fit Note or we may contact you to arrange an appointment.

Sick / Fit Note Request

Are you having to stay at home because of Coronavirus and need a note for your employer?
Is this a new request or extension of an existing sick note?
Please use this date format: DD/MM/YYYY.

Health History

Do you smoke?