Doctor’s 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 doctor may call you or arrange for an appointment.

If you have already been seen by your Doctor about this illness you will be able to collect your Fit Note after three working days.

Sick / Fit Note Request

Sick / Fit Note Request

If you are human, leave this field blank.

Full Name: *

Date of Birth: *

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

Phone Number:

Email Address: *

Date your illness started:

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

Number of days you were ill:

Include holidays and weekends, not just days off work.

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

Which practice do you want to collect the Sick / Fit Note from?

Whitchurch Surgery

Derrydown Clinic

Please note that the details you give will be used to update your medical records.