Reception; Requesting a Sick Note (MED3)

If you have already had a Sick Note (Fit Note) for this illness or you have already been reviewed by one of our team regarding the relevant illness your doctor may not need to see you to issue an additional Sick Note.

Please note that you may be contacted by our GP to discuss the request. Otherwise, if your request is approved we will send it securely to your mobile phone. We aim to complete the whole process within 2 working days. 

Please do not write any clinical queries on this form. Any clinical queries or request for appointments via this form will be discarded. To make an appointment either book online via the NHS app/Patient access or by calling reception 01926 331401. We will start to process your form by the next working day but it will take up to 2 working days to complete. Please DO NOT call before 2 working days as you will not receive a status update from reception or the administrative team. If you are NOT a registered patient then your form will be discarded. This service is only for patients registered at the surgery aged 16 and over; and for parents or legal guardians of children. Forms must be completed in the UK due to GDPR regulations.

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Reception; Requesting a Sick Note (MED3)
If your request is approved you will receive a text to confirm it is ready to collect.
If this date is not 28 days prior to today's date your sick note will be rejected as self-certification is now 28 days long. To find out more about the recent changes visit:
PLEASE NOTE THAT WE CANNOT USE A DATE IN THE FUTURE. Either today or a date in the past.
Please define the reason you are unable to work e.g. Recent heart attack
*Please define what adaptations in the textbox below
In kg or Stone

Please note: if you experience a fever (>37.8C) or a persistent cough (>4 hours) do not attend to collect your sick note. Instead self-isolate for 7 days & collect once this is over. Visit out Coronavirus page for more information.

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

Information submitted through all secure forms, with the exception of the Leamington Primary Care Network Coil insertion/replacement form and Implant insertion/replacement/removal form, is secured with a private key and is accessed over a secure connection by nominated staff. Information submitted through the Leamington Primary Care Network Coil insertion/replacement form and Implant insertion/replacement/removal form is sent to The Leamington Primary Care Network via secure email.

We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 365 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.