NHS GP

Requesting Fit Note (Med3)

The more information you put in this form, the more opportunity we have to help you with your Fit note request

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Your details: 

The next part of this form, is you opportunity to clarify why you are asking for a fit note.

Please email any supporting documents to docman.e84066@nhs.net

About This Form

Please note that we will use the  medical information you supply together with the information in your medical records, as part of the decision to provide you with a Med3.

The information you supply us will be used lawfully, in accordance with GDPR Regulations. GDPR gives you the right to know what information is held about you, and sets out rules to make sure that this information is handled properly.

Please note that by using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method of registration.

Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.