Request an Additional Sick Note Additional sick note request Your DetailsFull nameDate of birth Day Month Year PostcodePhone numberEmail address Sick/fit NoteFirst date you were not at work due to this illness Day Month Year Total number of days you were ill or is still ongoingDescribe your illness and why you need a sick / fit note OptionalPlease state how many days/weeks you require your sick note for OptionalComments OptionalThis field is for validation purposes and should be left unchanged.
