Doctor’s Sick/Fit Note Doctor’s Sick/Fit Note Sick CertificatePlease only fill this out if you already have an existing sick certificate and need an extensionIf 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 First Last Date of Birth DD slash MM slash YYYY PhoneEmail Optional Sick/Fit noteDescribe your illness or condition and why you need a sick/fit notePlease include details of any recent relevant hospital attendances.This will be the case from DD slash MM slash YYYY If the illness is still ongoing, how long do you think you will be away from work? Optional