Fit/sick note request

Fit notes

For periods of 7 days or less you are able to self-certify and the GP will not complete a fit note. Only use this form if you are you requesting an extension to an existing sick note, or you have consulted with a medical professional recently about this sickness.

Name
Known existing sickness
DD slash MM slash YYYY
When does this sick note need to start from?
DD slash MM slash YYYY
When should this sick note end? Please note this is at the GP’s discretion