Requesting an additional Sick / Fit Note

If you have already had a Sick Note (Fit Note) for this illness your Doctor may not need to see you to issue an additional Sick Note. Please complete this form. We will contact you to let you know when you can collect your Sick / Fit Note or we may contact you to arrange an appointment.

Sick / Fit Note Request

If you are human, leave this field blank.

*Please note that all MED3 requests are subject to GP review and approval and where clinically appropriate the duration of your MED3 may be amended. If necessary, the GP processing your request may be in contact with you to discuss it further. Requests for MED3s cannot be made in advance.*

Full Name: *

Phone Number:

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

Please use this date format: DD/MM/YYYY.

Last date you were not at work due to this illness: *

Please use this date format: DD/MM/YYYY.

Total number of days you were ill or state ongoing:

Occupation: *

Describe your illness and why you need a Sick / Fit Note: *

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Sick / Fit Note Request

New Patients