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Patient Request Form

Registered Patient Forms

If you are absent from work due to a condition which results in a hospital admission, a Fit Note may be issued by the hospital team to cover the period of time you were in the hospital and the expected rehabilitation period. If you require an extension of the Fit Note, please contact our admin team, ideally via PATCHS.

Please note that emergency or urgent appointments should not be used to request Fit notes.

Important Note to Remember

  • Illnesses of less than 7 days do not require certification
  • Minor ailments are not eligible for certification (e.g. prolonged flu/cold etc.)
  • Pregnancy and other conditions that are protected by the law do not necessarily require certification

Please Choose one of the following
First name
Last name

Fit Note Request Form

Please complete the below form ensuring all boxes are completed

Please Note: Patients must have self certified for 7 days before requesting a Fit Note certificate from a GP

Please Confirm

Private Letter Request

The practice may write a private report or letter in certain eligible circumstances. Please fill in the form below clearly stating your the reasons for your request. You may also upload any blank or pre-filled form that you wish the clinician to review.

First Name
Last Name

Maximum file size: 10MB