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 doctor may call you or arrange for an appointment.

Can you please call into the surgery (the surgery that you stated on your form), after 48 hours to collect your sick/fit note

Sick / Fit Note Request

Sick / Fit Note Request

If you are human, leave this field blank.

Section

Start date of this note:

Please use this date format: DD/MM/YYYY. Please be advised that this cannot be future dated.

Suggested duration of sick note:

Describe why you need a Sick / Fit Note

What Surgery would you like to collect your Sick/Fit Note from? * Adwalton House Surgery Shenstone House Surgery Windsor House Surgery