Sick Note Request Sick note request First, a few details about yourself Name * First Last * Last Date of Birth * Preferred Contact details if we need any clarification (Email or telephone number) * And now, about your need of a sick note What’s the condition you suffer from * Which doctor gave you the previous sick note? * Why do you think you need more time off? * When do you estimate you will be able to return to work? * Will you be able to work with amendments at the workplace? Or limited hours? * Submit If you are human, leave this field blank.