Sick / fit note extension

Please read the following information before submitting this request.

This form is for extending existing sick / fit notes only, it cannot be used to request an initial sick / fit note.

If you have already had a sick / fit note for your current illness, your clinician may not need to see you to issue another sick / fit note. If your clinician doesn’t need to see you, your sick / fit note will be available to collect from the Practice after two working days.

Please wait until one day before your existing sick / fit note runs out.

Use this form to help us direct you to the best place for requesting a sick note.

You may be asked to provide the number of days you have been sick for.

Calculate sick days

Here is how to calculate your total number of sick days.

Count all of the days in a row you have been sick
Include days that you would not normally work
Include weekends or bank holidays

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

Yes, this is my first request

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

First name

Last name

Phone number

Door number / property name

Post code

Tell us about your illness

Are you still ill with this illness?

Yes, I am still ill

No, I am no longer ill

Number of days you have been sick

Clinician you have seen

How long are you requesting this sick / fit note for?

Request email receipt

If you would like a copy of your submission, please tick the box below and supply an email address.

Send me an email receipt with the details from this form

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Requesting a doctor's sick / fit note

Requesting an additional sick / fit note

Tell us about your illness

Request email receipt

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