Request On-Going Sick Note


IMPORTANT

If your current sick note has not yet expired, please do not complete this form.

If you have already had a Sick Note (Fit Note) for a current illness your Doctor may not need to see you to issue an additional Sick Note. Please complete this form. We may contact you to arrange an appointment to discuss further or if you have not heard from us within 72 hours, your sick note will be ready for collection.

Last Updated: 29/11/2023

  • 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 fit note.

  • Additional Sick Note Request

    If your current sick note has not expired yet, please do not complete this form.

    Please complete once sick note has expired

    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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