Sick Note Extension

If you have previously had a sick note and still feel that you are not well enough to work, then you can REQUEST an extension to your current sick note. These certificates are called ‘Fitness To Work’ Certificates. The doctor may call you or arrange for an appointment. If you have already been seen by your Doctor about this illness your certificate will be sent to you within a week.

Last Updated: 02/04/2024

Your Details

Full Name *

Date of Birth *

Phone Number *

Email Address *

Sick/Fit Note

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

DATE THAT YOUR PREVIOUS SICK NOTE EXPIRED *

TOTAL NUMBER OF DAYS YOU WERE ILL OR IS STILL ONGOING *

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

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 held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. *

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Sick Note Extension

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