Requesting an Extension to a Sick Note

Requesting an Extension to a Sick Note

If you have already had a Sick Note for this illness, your Doctor may not need to see you to issue an extension. Please complete this form, and we will let you know when you can collect your new Sick Note.  We may contact you for more information, or to arrange a review appointment, if that is required.

 

This form is ONLY for use by patients who already have a Sick Note that has been issued by a Healthcare Professional in the Practice, and who require an extension. 

If you require a NEW Sick Note, you must contact Reception and request an appointment.

  • Your Details

    Date of Birth
    For example, 15 3 1984

  • Sick Note Extension Request

    Please Note:  sick notes are legal documents and can only be issued from the date they are due. They can be back-dated to a date that has passed, but cannot be forward-dated to a date in the future. If you request an extension before your current sick note has expired, it will not be processed.

    When does your existing sick note expire?
    For example, 15 3 1984
    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.
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Page last reviewed: 03 March 2026
Page created: 12 February 2026