Fit (Sick) Note

 
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All questions marked with a * are mandatory

Have you seen a doctor (either GP, hospital or privately) about this issue?: *

If you have not recently been seen about this issue, you must contact the surgery to book a routine appointment with a GP to be reviewed prior to a sick note being issued or otherwise your request may be ignored.

 
Book an appointment
 

You may continue on with the form

Fit (Sick) Note

You do not need a sick note for the first 7 days of an illness - you can still self-certify your illness.

  • For isolating due to COVID-19 you can get an isolation note for up to 14 days via NHS 111 Online
Please confirm you are a patient at Pencoed or Llanharan Medical Centre: *
Have you been off sick for more than 7 days?: *

If you have been ill for 7 days or less you don’t need to see a Doctor.

  • You can complete a Self Certification form yourself.
  • If your employer doesn’t have its own form your can complete the Employee's Statement of Sickness (SC2) form online. 
  • When you’ve filled in the form give it to your employer, it will help them decide if you can get Statutory Sick Pay. Keep a copy for your own information.

Some employers insist on a Doctor’s note regardless.

  • A Doctors note under these circumstances may involve a charge.
  • Please contact reception in these circumstances.
Have you already had a note about this?: *
E.g. could you work from home, do fewer hours, or do different tasks at work?
You are unable to continue to the next step (see above). : *
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Personal Details

Please provide your details to help us find your record. If you are filling this in on behalf of someone else, please enter their details.

Please double check you've entered the correct email address
May be used to identify you
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Confirmation

Please check the details are correct

  • Name: 
  • Date of Birth (yyyy-mm-dd): 
  • Phone Number: 
  • Email Address: 

Have you already had a note about this?
Your Answer: 

Tell us briefly about your illness or medical problem.
Your Answer:

When would you like the note to start? When do you think you can return to work?
Your Answer:

If possible, is there anything your employer could do to help you return sooner?
Your Answer:

How should we contact you?: *
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