Sick Note Request

Use this service to get a sick (fit) note for work following an absence of more than 7 days.

You can use this service if you:

Online form

What is your first name?

What is your last name?

Date of birth

Your gender

Male

Female

Other

Your address:

Street Address Optional Address Line 2 Optional City Optional ZIP / Postal Code Optional

Email address

Start date of sick / fit note:

End date for sick / fit note: *

Describe your illness and why you need a sick / fit note:

Are you happy for us to send you your sick/fit note digitally? *

Yes