Sick Note Request

Please fill out the form to request a sick note if you require one.

Once your request is submitted, it may take up to 72 hours or 3 working days to process. You will receive a text message with the note attached directly to your phone once it’s ready. Thank you for your understanding.

Keep in mind that you do not need a sick note for the first 7 days of an illness, as you can self-certify during this period.

Online form

Title (Mr./Mrs./Miss/Master/Mx)

Name

First Last

Name

Middle Optional

Date of birth

Your address:

Street Address Address Line 2 City ZIP / Postal Code

Email address

Start date of sick / fit note:

End date for sick / fit note:

Describe your illness and why you need a sick note

Are you happy for us to send you your sick/fit note digitally? *

Yes

Sick Note Request

Thank you for your feedback.