Doctor’s Sick/Fit Note for more than 7 days

If you have been ill for more than 7 days you will need a doctor’s certificate to receive sick pay, statutory sick pay or other incapacity related benefits. 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 your certificate will be sent to you within a week.

Your Details

Full Name *

Occupation / Job Title (e.g. Teacher, Gardener or Unemployed) *

Date of Birth *

Phone Number *

Email Address *

Sick/Fit Note

First date you were not at work due to this illness *

Date you hope to return to work (or date you returned to work) *

Please describe your illness and why you need a Fit Note *

How would you like to receive you Fit note? *

Collect from Medical Centre

Email to the address above

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.

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Page last reviewed: 03 April 2026
Page created: 23 March 2026

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Doctor’s Sick/Fit Note for more than 7 days

Doctor’s Sick/Fit Note for more than 7 days

Further Information