Fit Note Request

Request for Repeat ‘Fitness To Work’ Certificates

If you have previously been seen by a GP for your current illness you may be entitled* to a repeat Doctors Certificate. Please complete and submit the form below. *Please be aware in the event of the GP declining your request, you will need to book a routine appointment.

PLEASE DO NOT USE THIS FORM IF - you require a Doctors Certificate for either a new condition and have not yet seen a GP regarding this or a flare up of an exisiting condition and have not seen a GP regarding this recently, you must book a routine appointment with a GP first. Please telephone the practice on 02380844546 - Option 2 to book, routine appointments are released daily at 8am.

Last Updated: 01/12/2023

Your Details

Full Name *

Date of Birth *

Phone Number

do you consent to receiving text messages from us?

Yes No

Sick/Fit Note

FIRST DATE YOU WERE NOT AT WORK DUE TO THIS ILLNESS *

TOTAL NUMBER OF DAYS YOU WERE ILL OR IS STILL ONGOING *

DESCRIBE YOUR ILLNESS AND WHY YOU NEED A SICK / FIT NOTE *

This web form collects your name, date of birth, 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.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Cookies on the Forestside Medical Practice website

Fit Note Request

Further Information