For urgent help, contact your GP. If they are closed, visit [NHS 111 online](https://111.nhs.uk/) or call 111. In an emergency [call 999](https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-call-999/)

If you need more urgent help, call your GP practice. If it's closed, visit [NHS 111 online](https://111.nhs.uk/) or call 111. In an emergency [call 999](https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-call-999/)

What would you like help with?

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I have an admin or routine care request

A medical statement about your fitness to work

Fit (sick) note

**Please keep your phone to hand as your request will be reviewed by the triaging GP and we will be in touch either but text or in person.**

If you need more urgent help, call your GP practice. If it's closed, visit [NHS 111 online](https://111.nhs.uk/) or call 111. In an emergency [call 999](https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-call-999/)

**Do not use this form to request help for new or ongoing symptoms**

[Get help for a medical problem](/patient-initiated/h81015)

If you're off work sick for **7 days or less**, your employer should not ask for medical evidence that you've been ill - **you do not need to complete this form.** Instead they can ask you to confirm that you've been ill by filling in a form when you return to work. This is called self-certification.

 **If you have been off work sick for 7 days or more, complete this form.**

Select if you've already had a note about this or not

Have you previously had a note about this?

Briefly describe your illness or medical problem

Enter a date in the past in the format DD MM YYYY, e.g. 31 12 2020

It is not possible to use a future date for a sick note.

Enter a date after the start date in the format DD MM YYYY, e.g. 31 12 2020

Provide an estimated date, but note that it might be amended by a clinician.

e.g. Work from home, reduced hours or different tasks

Can your employer do anything to help you return to work sooner?

Patient information