Sick (fit) note request

First date you were not at work due to this illness:

Please use this date format: DD/MM/YYYY.

Total number of days you were ill or state ongoing:

Describe your illness and why you need a Sick / Fit Note:

What date would you like the sick note to end? *

What is your job? *

What parts of your job are you unable to do? *

We could state on the note that you may be fit to work with the help of a phased return, altered hours, amended duties or workplace adaptations.

Do you think you may be fit to work? *

Yes

No

Please explain what changes would be needed to allow you to work: *

Tell us whether you accept cookies