Sick (fit) note request

First date you were not at work due to this illness:

Please use this date format: DD/MM/YYYY.

Date that you intend to return to work: *

This can be approximate. Please use this date format: DD/MM/YYYY.

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

What aspect of your illness prevents you from working? *

Could your work make any adaptations to help you get back to work sooner? *

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