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Sick notes

Please fill out our virtual sick note:

Sick / Fit Note Request with Intelligence

Is this your first sick / fit note for this illness?

Yes

No, I have already had a sick / fit note for this illness

First Sick / Fit Note

How long have you been ill (including holidays and weekends)?

7 days or less

More than 7 days

If you have been sick for more than four days in a row, but less than seven, you can self–certify your illness using a SC2 form available online from HMRC.

Many employers have their own self-certification forms. You do not need to see a Doctor.

Requesting an additional Sick / Fit Note

If you have already had a Note for this illness your Doctor may not need to see you to issue an additional Note. Please complete this form. We will contact you to let you know when your Note is ready or we may contact you for more information.

Are you self-isolating because you, or someone you live with, has symptoms of coronavirus?

Yes

Isolation Note from 111

Please check the NHS guidance on self-isolating here www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-advice/.

You can get an isolation note from 111 online to give to your employer. You do not need a sick note from the surgery.

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 surgery may call you for more information.

If you have already been seen by your Doctor about this illness your certificate will be sent to you within a week.

Please complete the form below.

Your details

First Name *

Last Name *

Email ( This will be used to send you your sick note ) *

Enter Email

Confirm Email ( This will be used to send you your sick note ) *

Confirm Email

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Are you happy to have this sick note sent to you as a text message?

Your Illness

First date you were not at work because of this illness *

Number of days you have been unwell or state ‘ONGOING’ How long do you want this note to last? *

You should specify your full period of illness including weekends and holidays, not just days off work.

What exact dates is this note to cover?*** important *

You should specify your full period of illness including weekends and holidays, not just days off work.

What is the reason you cannot work? What would you like the note to say? *

Describe your illness and why you need a Sick / Fit Note.

Privacy Policy

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. 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. I have filled out the form in full and have specified the dates that I need this note to cover.

Albany House Surgery

Sick notes

First Sick / Fit Note

Requesting an additional Sick / Fit Note

Isolation Note from 111

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

Your details

Your Illness

Privacy Policy

Health A-Z

Live Well

Medicines Guide

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