Please complete this form if your state of health means that you are unable to work when a recent sick note (‘Fitness to Work Certificate’) ends.

The doctor may call you or arrange for an appointment.

If the doctor has enough information to issue a new sick note, we will try to have this ready for collection within 5 working days. Please note that Fit notes can be back dated so any time off will be accounted for

It is not normally necessary to see a doctor before your return to work at the end of the sickness period and you can go back to work sooner if you feel well enough.