Requesting a extension of Sick/Fit note

This form is only to be used if this is an additional sick note, and you have already seen a GP for your first.

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 this form. We will contact you to let you know when you can collect your Sick/Fit Note or we may contact you to arrange an appointment.

Patient Information.

What is your full name? *

What is your date of birth? *

Where is best to contact you regarding this form? *

Reasons for requiring extension - this must be an extension, and not your first instance.

What date do you require the fit note to begin? *

Describe your reason for needing a fit note/extension. *

How many days/weeks do you require your fit note for? *

Which doctor did you see for your initial note? *

By completing this form you consent to us collecting your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. *

I am happy to proceed.

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Page last reviewed: 03 June 2025

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Requesting a extension of Sick/Fit note

Requesting a extension of Sick/Fit note

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