V5 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 Notes cannot be issued in advance, but they can be backdated.

Please note we are unable to issue a sick note until day 8 of illness. You can self-certify for up to 7 days with your employer.

We aim to turn around Sick Notes within 72 hours- We do not issue them urgently

This form is not for the first Sick Note of your illness.

PLEASE NOTE YOU MUST SPECIFY THE TIME PERIOD OF THE SICKNOTE OR THIS COULD DELAY ISSUE OF THIS NOTE.

Last Updated: 20/06/2023

Sick/Fit Note Request

Full Name *

Date of Birth *

Phone Number

Email Address *

Additional Sick/Fit Note Request

PLEASE ANSWER ALL QUESTIONS

DESCRIBE YOUR ILLNESS AND WHY YOU NEED A SICK / FIT NOTE *

WHEN DO YOU WANT THIS EXTENSION SICK NOTE TO START FROM *

PLEASE STATE HOW LONG YOU NEED THE SICK NOTE FOR *

DO YOU WISH TO COLLECT THE SICK NOTE OR HAVE IT SENT ELECTRONICALLY TO YOUR MOBILE *

COLLECT FROM SURGERY

SEND ELECTRONICALLY

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V5 Requesting an additional Sick / Fit Note

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