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Personal Details

Please provide your details to help us find your record. If you are filling this in on behalf of someone else, please enter their details.

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May be used to identify you
 
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Request a Med3 (Fit / Sick Note) Online

 

You do not need a sick note for the first 7 days of an illness - you can self-certify to cover this period.

 

If you have been ill for 7 days or less, you do not need to see or consult with a Doctor. You can complete a Self Certification form yourself.

Many employers have their own self-certification forms. If your employer does not have their own form, you can complete the Employee's Statement of Sickness (SC2) form online. 

Once you have completed the form, share this with your employer; it will then help them decide if you qualify for Statutory Sick Pay (SSP). Be mindful to keep a copy for your own records.

 

Some employers insist on a Doctor’s note regardless of the above. As this is not an NHS service, doctors' notes, under these circumstances, will incur a charge. For more information on this, please see our Private Work section.

Please include as much information as possible, including any previous sick notes dates, etc.
Please include as much information as possible
E.g. could you work from home, do fewer hours, or do different tasks at work?
 
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Confirmation

Please confirm your details are correct

(please note your form will not be received by the Practice until you press the green SUBMIT FORM button below.)

 

Date of Birth:

Gender:

Phone Number:

 

Query: Fit (Sick) Note

Have you already had a note about this?

Tell us briefly about your illness or medical problem

When would you like the note to start? When do you think you can return to work?

If possible, is there anything your employer could do to help you return sooner?

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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General Enquiries