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Staunton & Corse Surgery NHS GP Surgery in Gloucestershire

Sick (fit) note request

Sick / Fit Note Request

Section

Which type of request do you need? *

Sick/fit note request for a new illness, not yet discussed with a clinician

Sick/fit note request for an ongoing illness that I have received a note for in the last 3 months

Please note that you may be asked to consult with a clinician via telephone or in person.

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:

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

If you are human, leave this field blank.

Gloucester Road
Corse
Gloucester
Gloucestershire
GL19 3RB

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01452 840228

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