Requesting an additional Sick / Fit Note

This form is intended to be used by patients registered with Sandy Health Centre only. We are not able to respond to any requests from non-registered patients.

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 complete this form. We will contact you to let you know when you can collect your Sick / Fit Note or we may contact you to arrange an appointment.

If you are requesting an extension to your current sick / fit note, you will need to request this at a maximum of two days before it expires.

Sick Note Self-Certification Extension Period

The Department of Work & Pensions is making legislative changes meaning that from Friday 17 December 2021, self-certification for sickness will be extended from 7 to 28 days for people accessing Statutory Sick Pay, and there will be no requirement for a sick note to access any other benefits. This time-limited change will end on 26 January 2022.

Sick / Fit Note Request

Sick / Fit Note Request

For what purpose are you requesting a statement of fitness to work? *
Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY.