Requesting an additional Sick / Fit Note

If you have already had a Sick Note (Fit Note) for this illness your Doctor may not need to see you to issue an additional Sick Note. Please complete this form. We will contact you to let you know when you can collect your Sick / Fit Note or we may contact you to arrange an appointment.

Sick / Fit Note Request

If you are human, leave this field blank.

Is this your first sick note for this illness? *

Yes

Dates of previous sick note: *

Please use this date format: DD/MM/YYYY-DD/MM/YYYY

Have you seen a clinician for this illness? *

Yes

First date you felt unwell: *

Please use this date format: DD/MM/YYYY

Start date of sick note: *

Please use this date format: DD/MM/YYYY

How long would you like to request a sick note for? *

Reasons for sick / fit note request (please give as much detail as possible): *

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Sick / Fit Note Request

BSL999