Sick (fit) note request

Have you already had a Sick Note (Fit Note) for this illness? *

Yes

No

Sick Note (Fit Note) Expiry Date: *

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

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:

Tell us whether you accept cookies