Trinity & Bowthorpe Medical Practice NHS GP Surgeries in Norwich

Sick (fit) note request

Additional Sick / Fit Note Request

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What date would you like the sick note to start?

Please use this date format: DD/MM/YYYY.

What date would you like the sick note to end? You will be covered until the end of this day.

Describe your illness and why you need a Sick / Fit Note:

What is your job? What parts of your job are you unable to do?

If you like, we could state on the note that you may be fit to work with the help of a phased return, altered hours, amended duties or workplace adaptations. Please see the government guidance on Fit Notes.

Do you think you may be fit to work? Please explain what changes would be needed to allow you to work.

I confirm that I am not using this form to request medical help.

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Sick (fit) note request

Section