Doctor’s Sick/Fit Note for more than 7 days

If you're off work sick for 7 days or less, your employer should not ask for medical evidence that you've been ill - you do not need to complete this form. Instead they can ask you to confirm that you've been ill by filling in a form when you return to work. This is called self-certification.

If you have been off work sick for 7 days or more, complete this form.

Last Updated: 26/03/2025

Your Details

Full Name *

Date of Birth *

Phone Number

Email Address *

Sick/Fit Note

Have you previously had a note about this? *

Yes No

Briefly describe your illness or medical problem *

When should the sick note start? (It is not possible to use a future date for a sick note) *

When should the sick note end? (Provide an estimated date, but note that it might be amended by a clinician) *

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. *

I consent to the practice collecting and storing my data from this form.

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Doctor’s Sick/Fit Note for more than 7 days

Further Information