New Sicknote Request – Almond Group Practice

Please fill out this form to request a Sicknote for a new episode of illness.

If you have had previous sicknote for the same illness then please fill out the Sicknote Extension form.
As this is a Sicknote for a new episode of illness we may call you to discuss this.

How long have you been ill (including weekends)

7 days or fewer

> 7 days

If you have been sick for fewer than seven days in a row, you can self–certify your illness using the online HMRC form.

Many employers have their own self-certification forms. You do not need to see a Doctor.

Patient Name

Date of Birth

Mobile number to contact you

Reason for being off work

Occupation

Self-Certification End date

When you hope to return to work?

Please give us a bit more information if you feel it may help us.

How would you like to receive your Sicknote?

Email

collect from Kirkliston Reception

collect from Winchburgh Reception

Your Email

Privacy Policy

We use your information to provide healthcare and update your medical record. We may share relevant information with NHS services involved in your care. For full details, please see our Privacy policy.

Consent

I agree to the privacy policy