Sickness Certificates

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 by visiting the HMRC website. If you likely to be off for more than 7days, you are advised to arrange an appointment to see a Doctor to assess your fitness to work.

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 you sick note expires, you do not need to obtain a separate return to work certificate or ‘fit note’ from your GP. If you are well enough to return to work before your sick note expires, you can do this after discussion with your manager. For more information for employers and employees about sick notes click here

Sick Note Request form

Info: if this is the first sick note you have received for this particular problem, you will usually need to speak to a doctor before it can be issued.

Sick Note Request V03

Preliminary Question

Are you asking for a renewal of a sick note that you have been given within the last six months?

Yes

Complete a Consultation Request

Please complete a consultation request instead and state that you are asking for a new sick note with requested start and end dates in the section about how you think we can help you.

Consultation Request

Your details

First Name *

Last Name *

Email *

Date of birth *

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

Phone Number *

Sick note details

When did/does your last sick note finish? *

What is the condition you are suffering with that prevents you from working? *

What is your job or are you unemployed? *

How does the condition prevent you from working? *

What type of note do you need? *

I am unable to work at all

I may be able to work taking account of the following advice

What work could you do? *

I could work with altered hours or duties

I need a phased return to work (this is usually over 2 or 4 weeks depending on how long you have been off)

I need a note asking for adaptations at work

You can choose more than one option.

Please provide as much detail as you can, to help us with your request *

On what date do you need the note to start? *

We cannot backdate to a time before you have seen any doctor about this condition

When do you hope to return to work or when do you need the note to continue until? *

If we need to review your condition, we may issue a sick note for a shorter period than you request

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 held by the practice and our partners in the NHS. 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.

If you are human, leave this field blank.

Private Certificates

If you or your employer require further information concerning your period(s) of illness , then your Doctor may require to issue you with a letter. Please note that a charge will apply for this service.