Fit note extension form - Lochgilphead Medical Centre

Doctor’s Sick/Fit Note- Extension

If you remain unwell at the expiry of your Fit note, you will need a further doctor’s certificate to receive sick pay, statutory sick pay or other incapacity related benefits. The doctor may call you or arrange for an appointment if we have not spoken to you about your illness for some time. If we are able to issue a further Fit note without speaking to you we aim to do so within 2 working days.

Your Details

Full Name *

Occupation / Job Title (e.g. Teacher, Gardener or Unemployed) *

Date of Birth *

Phone Number *

Email Address *

Sick/Fit Note

Date you believe your current Fit note expired (note we will check this and ensure a further Fit note is continuous) *

Date you hope to return to work (or date you returned to work) *

Please describe your ongoing illness, why you need a Fit Note and, if appropriate, steps being taken to make return to work possible *

How would you like to receive you Fit note? *

Collect from Medical Centre

Email to the address above

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. *

I consent to the practice collecting and storing my data from this form.

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Page last reviewed: 03 April 2026
Page created: 03 April 2026

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Doctor’s Sick/Fit Note- Extension

Doctor’s Sick/Fit Note- Extension

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