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Sick note request form
In order to request for a sick note please complete the following form below
If it is a sick note request for ISOLATION please visit:
https://111.nhs.uk/isolation-note/
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* Indicates required question
YOUR DETAILS
Please include your latest personal details so that we can contact you if necessary
Your Full Name
*
Your answer
Your Date of Birth
*
Please include your DOB in the form of DD/MM/YYYY i.e 01/01/1980
MM
/
DD
/
YYYY
Your MOBILE number
*
If we need to contact you to clarify your answers especially if your asthma is poorly controlled
Your answer
Your EMAIL address
*
Your answer
SICK NOTE REQUEST
What type of sick note are you requesting?
*
What type of sick note do you require a letter for absence of work or a note stating
SICK note: I am NOT fit for work
I CAN be fit for work but require amended duties i.e. hours, responsibility
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