Requesting an additional Sick / Fit Note LMP

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 note that sick notes cannot be forward dated, please do not request early as these will not be processed until the due date.

Sick/Fit Note Request

Full Name *

Date of Birth *

Phone Number *

Email Address *

Additional Sick/Fit Note Request

DATE CURRENT FIT NOTE ENDS *

LENGHT OF TIME YOU WOULD LIKE THIS CERTIFICATE TO COVER *

ANY CHANGES TO THE REASON FOR THIS CERTIFICATE *

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: 14 May 2026
Page created: 14 May 2026

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Requesting an additional Sick / Fit Note LMP

Requesting an additional Sick / Fit Note LMP

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