Woodbank Surgery

0161 705 1630

Phone lines open 8.00am to 6.30pm

Sickness Certificates

You do not require a doctor’s sickness certificate for any illness lasting seven days or less. Your employer may however require you to complete a self-certification form (SC2) which is available from your employer or on the HMRC website.

YOU DO NOT NEED TO ATTEND FOR A GP APPOINTMENT FOR ALL SICK/FIT NOTE REQUESTS: 

If you have been seen by a Doctor or Nurse Clinician and have received your first sick note, you may apply for an extension by completing the form below.

 

Sick Note Request Form

Please note that this form must be completed in full, submitting an incomplete form may result in a delay in your sick note extension request being processed. Sick note extension requests will only be processed when they are due; under no circumstances are we able to provide a post-dated sick note. Sick note extension requests will only be processed if the patient has been seen by a GP, Advanced Practitioner or hospital consultant in the proceeding 8 weeks.
Title(Required)
DD slash MM slash YYYY

DATES REQUIRED FOR SICK NOTE

DD slash MM slash YYYY
DD slash MM slash YYYY
Hidden

OFFICE USE ONLY

Hidden

CLINICAL ASSESSMENT OF SICK NOTE EXTENSION REQUEST

Hidden
Hidden
NOTES CHECKED (please tick)
Hidden
REQUEST APPROVED: (please tick)
Hidden
Hidden

GP AUTHORISATION FOR SICK NOTE EXTENSION TO BE PROCESSED

Hidden
Hidden
APPROVED: (please tick)
Hidden
IF SICK NOTE REQUEST IS NOT APPROVED PLEASE GIVE FURTHER GUIDANCE BELOW

Date published: 8th July, 2021
Date last updated: 8th July, 2021