Fit Note for more than 7 days

If you have been ill for more than 7 days and need a certificate. These certificates are called ‘Fit To Work Certificate’. A health profession may call you or arrange for an appointment before issuing the Fit for Work Certificate.

Last Updated: 29/03/2023

Your Details

Full Name *

Date of Birth *

Phone Number *

Email Address *

Sick/Fit Note

Is this a continuation note? *

Yes No

First date you were not at work due to this illness: *

Have you been off work for more than 7 consecutive days? *

Yes No

What dates is the sick note requested to cover? *

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. *

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

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Fit Note for more than 7 days

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