Request a Sick / Fit note - Dickenson Road Medical Centre

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 for an appointment.

If you have already been seen by your Doctor about this illness your certificate will be sent to you within a week.

For more information, please see NHS: When do I need a fit note?

Your Details

Full Name

First Last

Date of Birth

Email Address

Contact Number

You do not need a sick note for the first 7 days of an illness – you can still self-certify your illness.

For isolating due to COVID-19 you can get an isolation note for up to 14 days here: 111.nhs.uk/isolation-note/

Have you been off sick for more than 7 days?

Yes

Have you already had a note about this?

Yes

Tell us briefly about your illness or medical problem

When would you like the note to start? When do you think you can return to work?

If applicable, is there anything your employer could do to help you return sooner? Optional

Eg: Working from home, fewer hours, different tasks at work?

Comments Optional

This field is for validation purposes and should be left unchanged.