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Fit (sick) note request

If you’re off work sick for 7 days or less, your employer should not ask for medical evidence that you’ve been ill – you do not need to complete this form. Instead they can ask you to confirm that you’ve been ill by filling in a form when you return to work. This is called self-certification.

If you have been off work sick for 7 days or more, complete this form.

You can use this service if you:

  • are registered at the surgery

Before you start

We’ll ask you for:

  • your first and last name, date of birth, sex, postcode, email and phone number
  • if applicable, the details of the person you are completing the form on behalf of
Start now

You can also phone us on 0121 747 8291.

Page published: 26 July 2023
Last updated: 8 August 2025