Parkwood Surgery

Parkwood Drive, Hemel Hempstead, HP1 2LD

Telephone: 01442 250 117

Sorry, we're currently closed. Please call NHS 111

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Med3 Sick/Fit Note Form

Medical Certificate (sick/fit note) Request

Employees can take time off work if they are ill. You will need to give your employer proof if they’re ill for more than 7 days. https://www.gov.uk/taking-sick-leave If you’re ill just before or during your holiday, you can take it as sick leave instead. If employees are self-isolating and cannot work because of coronavirus (COVID-19) they can get an ‘isolation note’ online from NHS 111. They do not have to go to their GP or a hospital. If you have been ill for 7 days or less please complete the Statutory Sick Pay (SSP) Form : SSP If you have been ill for more than 7 days then please use the form below to request a medical certificate (sick/fit note). Pease allow 5 day s for the processing of this form. Doctor’s Sick / Fit Note for more than 7 days. If you have already had a Sick Note (Fit Note) for this illness your Doctor may not need to see you to issue an additional Sick Note. Please complete this form. Sick Note (Fit note) can take up to 5 working days to be completed. If the Doctor does need to see you then we will contact you to arrange an appointment.

Name*
First Last
Date of Birth*
DD slash MM slash YYYY
Contact Phone Number:*
Email address:*
Have you been ill for more than 7 days?*
Yes I have been ill with this concern for more than 7 days
Is this your first sick / fit note for this illness?*
- No - This is a continuation of a current sick/fit note
- Yes - This is my first sick/fit note for this concern
Please select the date you wish for the sick/fit note to start:*
DD slash MM slash YYYY
Please select the date you wish for the sick/fit note to end:*
DD slash MM slash YYYY
If you have been ill for more than 7 days:
Please describe your illness and why you are requesting a Sick / Fit Note:
How would you like us to send you this sick/fit note?*
- via text message
- collect in person from the main surgery
Comments
This field is for validation purposes and should be left unchanged.

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Parkwood Surgery Opening Times

Monday
08:30 until 18:30
18:30 - 20:00 Pre-booked appointments only!
Tuesday
08:30 until 18:30
07:00 - 08:30 Pre-booked appointments only!
Wednesday
08:30 until 18:30
07:00 - 08:30 Pre-booked appointments only!
Thursday
08:30 until 12:30
13:30 until 18:30
12:30 - 13:30 Closed for staff training
Friday
08:30 until 18:30
Saturday
CLOSED
Alternate Saturdays for pre-booked appointments only!
Sunday
CLOSED