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LOCKSIDE MEDICAL CENTRE

85 Huddersfield Road, Stalybridge SK15 2PT

Telephone: 0161 303 7200

We are open, Please follow the Green Tile (Request help including Appointments) on the Home page to fill out the online consultation form. Thank You

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Fit Notes / Sick notes

A Fit note is a doctor’s confirmation that you are not well enough to work or to look for work. It used to be called a Sick note and is also known as a ‘statement of fitness to work’ or a Med 3. You do not need a doctor’s note for any illness lasting 7 days or less. Your employer may ask you to complete a self-certification form (SC2) which is available from your employer or on the HMRC website.

If your condition is being managed by another service, like a consultant or hospital clinic they need to provide your note as they are assessing and making decisions about your fitness for work, not the GP.

Request a Fit note for work

Request a Fit note for Universal credit or ESA

Request a Fit note following hospital treatment, surgery or fracture

Lockside Medical Centre

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"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Name*

Prefix First Last

I would like to update my name.

Tick here for more options.

You do not need to provide a reason for this change, but an example could be marriage/divorce or changes made by deed poll.

New Name

Prefix First Middle Last

You do not need to provide a reason for this change, but an example could be marriage/divorce or changes made by deed poll.

Date of Birth*

Address (Current/Previous)*

Street Address Postcode Country

This should match the address we have on file for you.

TICK HERE*

My address remains the same.

I need to update my address.

New Address

Street Address Postcode Country

Please provide the Name & DOB of ANY members of your household that have moved to the same address.*

ONLY REQUIRED IF YOU ARE PROVIDING A CHANGE OF ADDRESS and family members are currently registered with us. Please note 'NA' if this is not applicable to you.

Phone (Current/Previous)*

Email (Current/Previous)*

TICK HERE*

My contact details remain the same.

I need to update my contact details.

New Phone Number

New Email*

Smoking Status*

How many a day?*

How often?*

This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Date of birth(Required)

Phone(Required)

Is this:(Required)

A new episode of illness

An extension to an existing sick note

If this is a new episode of sickness, have you self certified for the first 7 days?(Required)

Yes

This is an extension to an existing sick note

If this is a new episode of illness and you have self certified for 7days. Please provide the date this ended.(Required)

Please note if you have self certified for 7 days, you will be covered for the 7th day, please provide the following date for this to be continued. If not applicable pleas state - NA

If this is an extension to a Fit note, when does your current note run out?(Required)

If not applicable please state - NA.

Please let us know what medical condition is preventing you from working.(Required)

Please tell us how your symptoms would make it hard for you to do your job at the moment. It is helpful if you tell us a little about your job.(Required)

Is there anything your employer could do to adapt your job so that you may be able to work in some capacity? This could be a change in role, adaptations or altered hours.(Required)

Yes/possibly

If you answered 'Yes/possibly', please give details

How long do you feel you will need to be off work?(Required)

This will be assessed by a GP who may contact you for a further assessment.

Receiving your Fit note(Required)

I am happy for the practice to text the Fit note to me

I would prefer to collect a paper version of the Fit note from the practice

Please tick one of these boxes. Our preference is to send it by text as this is better for the environment. If collecting in person, please allow 2 working days.

Is there anything else you need us to know with regard to your Fit note request?