Doctor’s Sick/Fit Note

Doctor’s Sick/Fit Note

Sick Certificate

Please only fill this out if you already have an existing sick certificate and need an extension

If you are off work because of ill health for more than seven days your employer will normally ask for a Fit Note (or Statement of Fitness for Work) from your GP or hospital doctor. A Statement of Fitness for Work is sometimes referred to as Fit Note, Medical Statement, Doctor’s Note, MED3 or eMED3. Please complete this questionnaire if you wish to be considered for a Statement of Fitness for Work. If you are off work for seven days or less, your employer should not ask for a Statement of Fitness for Work. Instead, they can ask you to confirm that you have been ill. You can do this by filling in a form yourself when you return to work. This is called self-certification.
Name
DD slash MM slash YYYY

Sick/Fit note

Please include details of any recent relevant hospital attendances.
DD slash MM slash YYYY