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Clarendon Lodge Medical Practice
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Self Certification

Self certification form
Private Sick Note Request

If you have been ill for 7 days or less you don’t need to see a Doctor. You can complete a Self Certification form yourself. However some employers insist on a Doctor’s note regardless. A Doctor’s note under these circumstances may involve a charge.

Many employers have their own self-certification forms. If your employer doesn’t have its own form you can download the Self Certification Form. Please print it, fill it in and hand it in to your employer. You do not need to see a Doctor.

In cases where your employer still requires a sick note we will be able to complete a private sick note. This will cost £25. 

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Clarendon Lodge Medical Practice

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

  • 01926 331401
  • enquiries@clmp.nhs.uk (Please do not send clinical queries or attachments to this email address. They will be discarded. Instead use our online forms found on the homepage)
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