Sick note request (MED3)

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Please note that for the first 7 calander days that you are unable to work through sickness you can complete a self certification form. This form can be obtained from your employer. NOTE: The Surgery cannot issue self certification forms.

If you are in hospital, they will provide you with a sick note. They should also include any period necessary after you leave hospital. If necessary, we can extend this when you return home.

After the first 7 days, you will need a sick note from us. If you feel you require time of work due to sickness and have not been reviewed my a medical professional then please call reception to arrange a review with our medical team. 

If you want to see your doctor solely to extend a current sick note OR have already been reviewed by one of our team then this does not need to be a telephone call. Please complete the form below and we will get back to you with the outcome. 

 Private Sick Notes

 

If you want a note to confirm sickness within the first 7 days of absence this will require a private note for which a fee is due.

 

  

1 Sick note request (MED3)

Please define the reason you are unable to work

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.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 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.


Clarendon Lodge, 16 Clarendon Street, Leamington Spa, Warks, CV32 5SS
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