Sick Note - Return to Work Form

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Personal Details
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Fit Note & Return to Work

Doctors issue fit notes to people to provide evidence of the advice they have given about their fitness for work. They record details of the functional effects of their patient’s condition so the patient and their employer can consider ways to help them return to work.

Please select below if you require a fit note or a return to work with amended duties

Please be specific

Fit notes can NOT be collected from any of our sites

Please note our primary method for sending is by text message.  If you don't supply a mobile number, we'll use your email address as an alternative.  Please tick the boxes below to consent to this communication.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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