Doctor’s Certificate / Sick Line Request

Our clinical team can only provide a Fit Note (also known as a sick line, Med3 or Doctor's certificate) if you have been unable to attend work due to ill health for more than 7 consecutive calendar days, or if your request is for the continuation of a current Fit Note.

If you have been unable to attend work due to ill health for less than 7 consecutive calendar days then your request for a Fit Note will not be be processed as you are required to self certify for this period of time.  You should contact your line manager or HR department to arrange this. 

Please provide as much detail as possible when completeing the undernoted form. If our clinical team are satisfied with the details you have provided your Fit Note will be issued, however, if they require further information, you will be contacted by our andmin or clinical team. Once your Fit Note is issued it will either be posted to your home address, emailed to you or left at reception for you to collect.

If your request is for a continuation of your current Fit Note then please provide as much detail as possible and a projection of how much more time you think you will need to be off for. If you are unsure, and feel you need to speak to a clinician about this then please request this in the 'describe your illness' section in this form.

Last Updated: 15/07/2022

Your Details

Sick/Fit Note