Sick Note Form

Self-certification

If you are off work for 7 days or less, you do not need to give your employer a sick note or other proof of sickness from a healthcare professional.

When you return to work, your employer can ask you to confirm you've been off sick. This is called ‘self-certification’.

You can self-certify online at GOV.UK

If you are off work for more than 7 days in a row due to sickness, you must also give your employer a fit note (sometimes known as a sick note). You should count non-working days, including weekends and bank holidays.

Sick Note 

If your current sick note has not yet expired, please do not complete this form. we are only able to issue a sick note on the day that your current sicknote ends.

The practice will contact you within 72 hours to inform you of the outcome of your sick note request, or if an appointment is needed. 

Last Updated: 22/01/2024

  • Sick Note

    Is this your first sick note request for this specific condition?

  • Personal Details

    Failure to complete all form details will result in your request being rejected by the Practice. It is important that you provide as much detail as possible to enable the GP to assess your request for a sick note. 

    Date of Birth
    For example, 15 3 1984

  • Sick Note Request

    If your current sick note has not yet expired, please do not complete this form. We are only able to issue a sick note on the day that your current sicknote ends.

    Date sick note required from
    For example, 15 3 1984
    How would you like to receive your sick note?

  • Consent

    This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow Waterfront Medical Centre to contact you, and to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy for more information on how we protect and manage your submitted data. I consent to Waterfront Medical Centre collecting and storing my data submitted via this form.
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