Request a Fit Note

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

If you’re off work sick for more than 7 days, your employer will usually ask for a fit note (or Statement of Fitness for Work) from a healthcare professional. Fit notes are sometimes referred to as medical statements or a doctor’s note.

If you need a fit note, contact the healthcare professional treating you in the first instance. This should be a doctor, nurse, occupational therapist, pharmacist or physiotherapist. Please only fill in this form if you need to request a fit note from your GP.

Your request will be reviewed by the GP within 3 working days. You may be contacted if the GP requires more information from you. We will contact you to confirm if your request was approved or denied. The GP reserves the right to deny a request for a fit note following assessment of the information you have provided.

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Patient details

DD slash MM slash YYYY
This is a request for:*
Do you need a note that advises that:*
DD slash MM slash YYYY
(Please note that we can backdate fit notes, but cannot issue fit notes with a future start date.)
DD slash MM slash YYYY


The information you provide in this form will be processed by Cedar Practice. The information will be treated as confidential and stored in a secure data centre located in the UK. The information will be uploaded to your record in the practice’s clinical system as soon as possible after submission, after which the copy of your information in the data centre will be securely destroyed.

Please note that by using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of providing this information.

The information you provide will be processed with the sole purpose of providing you with Direct Care within the surgery and in support of Direct Care elsewhere. Our Privacy Policy provides further detail about how we process your personal information for the purposes of Direct Care.

You have the right to revoke this Consent to the terms laid here, in writing, signed by you. However, such a revocation shall not affect any disclosures we have already made in reliance on your prior Consent.

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