New Doctor’s Sick Note for more than 7 days

Doctor’s Sick Note for more than 7 days

Please note we need to minimum of 3 working days to process this request.

We do not accept sick notes until the day they are due as the GPs cannot forward date them.

If you have been ill for 7 days or less, you don’t need to see a doctor. You can complete a Self-Certification form yourself. Many employers have their own self-certification forms. If your employer doesn’t have its own form, you can complete the Self-Certification from online. Please print it, fill it in and hand it in to your employer. You do not need to see a doctor

Self-Certification Form

If you have been ill for more than 7 days you will need a doctor’s certificate. These certificates are called ‘Fitness To Work’ Certificates. The doctor may call you or arrange an appointment.

Failure to complete all the form details will result in your request being rejected by the surgery. It is important that you provide as much details as possible to enable the GP to assess your request for a fit note.

Full Name

Date you are completing this form?

Date of Birth

Phone Number

Email Address

SICK/FIT NOTE

What is your Job?

What is preventing you from working?

Have you sought any help to return back to work?

FIRST DATE YOU WERE NOT AT WORK DUE TO THIS ILLNESS

What date does your sick/fit note need to start?

How long do you anticipate you will need it to be? (select date).

TOTAL NUMBER OF DAYS YOU WERE ILL?

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

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.

Yes

Oak Street Surgery