Sickness Certificates

The NHS provides sickness certification only after seven continuous days of illness. If you need a sick note to cover this period of sickness (less than 7 days) you should complete a Self Certification (SC2) form which is available from your employer or on the HMRC website. Please visit the Direct Gov website for full information about fitness for work following a period of sickness.

If you need a sick note (MED3) to cover a period of more than 7 days illness, please fill in the form below

If you require a paper form, please download the document (Sick note-MED3 request) and email it to baconlane.surgery@nhs.net or drop it off at the surgery.

Do I need a note saying I’m fit for work?

No. You decide when you are well enough to work and do not need the GP to say you are well enough even if you sick note has not expired yet

Sickness Certificates for Coronavirus/COVID 19 or Self Isolation

You can download a self isolation certificate at the following website: https://111.nhs.uk/isolation-note/

Sick Note Request Form (MED3)

Requests will take 7 working days to review

First Name(Required)

Surname(Required)

Date of Birth(Required)

Email(Required)

Telephone Contact

Why do you need this Sick Note?(Required)

Please select from the list

Other - Please give details

What kind of work do you do?

Is this a new Sick Note or an extension?(Required)

New Sick Note

Extension of previous sick note

Date became ill(Required)

Date would like note to commence(Required)

Date would like note to end?(Required)

When does your existing sick note expire?(Required)

Date you would like note to be extended to?(Required)

Do you need..(Required)

You Are Not Fit for work

You May Be Fit For Work Taking Account of the following advice

Please Select All That Apply

For You May Be Fit For Work

A Phased Return to Work

Altered Hours

Amended Duties

Workplace Adaptations

You May Be Fit For Work

Please advise what changes to your work would allow you to work in your current state of health. The doctor will consider this when putting advice regarding changes to your job to allow you to work

Nature of Illness(Required)

Please tell us why you need the Sick Note, why you can't work, events leading up to now and which clinicians you have seen so far (GP & Hospital)

Date hoping to return to work

Name

This field is for validation purposes and should be left unchanged.

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Bacon Lane Surgery

Monday
08:00am to 06:30pm
Tuesday
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Wednesday
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Thursday
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Friday
08:00am to 06:30pm
1300-1400 - Phone lines may be closed for practice meeting. We will reopen them as soon as the meeting is completed
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CLOSED
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