Sick/Fit Note

Sick/Fit Note request form

Please complete this form to tell us about your illness and we will direct you to the most appropriate form or service.

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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

No

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 *

Enter Email

Date of birth *

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

Phone Number *

Your Illness

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

Number of days you have been unwell or state ‘ONGOING’ *

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

What is the reason you cannot work? *

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.

Send

If you are off work due to a Hospital admission, a Sick Note can be issued by the Hospital to cover the period of time you were in the Hospital. Once discharged, your GP can issue a Sick Note, based on your Hospital discharge letter. If you think this is your situation, our Reception Team will assist you.

Please note a Sick or Fit Note can be backdated; please discuss this when you see your GP. Emergency or urgent appointments should not be used to request Sick / Fit notes.

Self-Certificate

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. You can obtain this form from your employer or the HMRC website.

More than seven days off sick

If you’re off work sick for more than seven days your employer will normally ask for a Fit Note (or Statement of Fitness for Work) from your GP or Hospital Doctor.

How to count sick days

When you work out the number of days that you’ve been sick, you need to count all the days in a row you’ve been sick, including days you don’t normally work such as weekends and bank holidays.

Statement of Fitness for Work

The Doctor will provide you with a Statement of Fitness for Work (‘Fit Note’) if you are still not well enough to work. Your employer will most likely request this statement as evidence to support payment of Statutory Sick Pay (SSP).

Further information is available at the Direct.Gov website.

When do I need a Fit Note?

The NHS Information website provides further details about Sick or Fit Notes.

Private Certificates

Requests by employers for sickness certification

Employers asking for a doctor’s statement for the first seven days of an employee’s sickness are referred to the “Statutory Sick Pay Manual for Employers” – National Insurance Contributions Series CA30, Paragraph 28, which states “…you (the employer) cannot ask for a doctor’s statement for the first seven days of a spell of sickness”.

The purpose of this regulation is to avoid the necessity for employees with minor, self-limiting illness or injury to use surgery appointments for the sole purpose of obtaining a medical certificate. We do not, therefore, issue certificates in these circumstances.

If employers have reason to inquire about a spell of sickness, they are advised to write to the doctor, including written permission from the employee concerned, when a report may be issued. A charge will be made for such a report.

Our current charge for a private medical certificate is £14.50.