Fitnote request

When do I need a fit note?

7 days off sick or less

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.Your employer will provide you with a copy of the Statutory Sick Pay (SSP) SC2 form for shorter periods of illness or complete it online.

More than 7 days off sick

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 GP or hospital doctor. Fit notes are sometimes referred to as medical statements or a doctor's note.

More information about when a Fit note is required

Information about Fitnotes for both employees and employers

Please select the practice location most relevant to this Online Form submission:

Fitnote request

Name

Date of Birth

Addresscomplete in full or we will not be able to action your request

Telephone number ( Fitnotes will be sent to your provided mobile number )

Please provide information why a fitnote is required? Note fitnotes are not provided within first week of illness - see guidance above. Please add as much detail as possible to support your request.

When do you need your fitnote to start?date

When would you like the Fitnote to end? - Please note your doctor will assess your case and may decide to shorten or lengthen this request based on your history

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Emsworth Medical Practice • North Street, Emsworth, Hampshire, PO10 7DD.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.