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

Full Name *

Date of Birth *

Phone Number

Email Address *

Additional Sick/Fit Not Request

FIRST DATE YOU WERE NOT AT WORK DUE TO THIS ILLNESS *

TOTAL NUMBER OF DAYS YOU WERE ILL OR STATE ONGOING *

DESCRIBE YOUR ILLNESS AND WHY YOU NEED A SICK / FIT NOTE *

PLEASE STATE HOW MANY DAYS/WEEKS YOU REQUIRE YOUR SICK NOTE FOR?

The information you provide on this form will be sent to our practice and used only to deal with your request. Depending on the form, this may include your contact details, personal information and health information. The practice may add it to your medical record and, where needed for your care, share it with other NHS and care services. To find out how we protect and use your information, please read our privacy policy on our website.

I confirm the information I’ve given is correct and I understand how it will be used

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Page last reviewed: 12 October 2026
Page created: 12 October 2026

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Requesting an additional Sick / Fit Note

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