Sick (fit) note request

First date you were not at work due to this illness:

Please use this date format: DD/MM/YYYY.

Total number of days you were ill or state ongoing:

How long have you been off work?

Have you completed a SC2 self certification form?

Yes

No

Date certificate is needed:

Please use this date format: DD/MM/YYYY.

How long do you need the certificate for?

Do we have a hospital discharge letter?

Yes

No

Do you have a diagnosis?

Yes

No

What is your diagnosis?

Describe your illness and why you need a Sick / Fit Note:

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