Requesting an Additional Sick Note - Empingham Medical Centre

If you have already had a Sick Note (Fit Note) for this illness your Doctor may not need to see you to issue an additional Sick Note.

Please complete and submit the form below. We will contact your to let you know when you can collect your Sick Note or we may contact you to arrange an appointment.

First Name

Last Name

Date of Birth

Contact Number

Date your illness started

Number of days you were ill

Include holidays and weekends, not just days off work.

Describe your illness and why you need a Sick Note

Email Optional

This field is for validation purposes and should be left unchanged.