Sick (fit) note request

Have you already had a sick note for this illness?

Yes

No

Date your illness started:

Please use this date format: DD/MM/YYYY

Number of days you were ill/Length of sick note required:

Include holidays and weekends, not just days off work.

Start date required for sick note:

Please use this date format: DD/MM/YYYY

End date required for sick note:

Please use this date format: DD/MM/YYYY

Describe your illness and why you need a sick note:

Can we contact you by email?

Yes

No

Can we contact you by text message?

Yes

No

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

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