Requesting an additional Fit Note

If you have already had a Fit Note for this illness your Doctor may not need to see you to issue an additional Sick Note. Please complete this form. We will contact you to let you know when you can collect your Fit Note or we may contact you to arrange an appointment, please allow 5 working days for the additional fit note to be sent.

Last Updated: 27/11/2023

Sick/Fit Note Request

Full Name *

Date of Birth *

Address *

Phone Number *

Email Address

Additional Sick/Fit Note Request

Have you already self certified OR had a recent fit note regarding this illness? *

Yes No

Please tell us the start date required for the fit note *

Please tell us the end date required for the fit note *

Describe your illness and why you need a fit note *

How would you like your fit note sending? *

text message

post

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.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Cookies on the The Waterloo Practice website

Requesting an additional Fit Note

Further Information