Sick (fit) notes Sick Note Request Online form What is your first name? What is your last name? Date of birth MM slash DD slash YYYY Your gender Male Female Other Your address: Street Address Address Line 2 City ZIP / Postal Code Email address Start date of sick / fit note: MM slash DD slash YYYY End date for sick / fit note: * MM slash DD slash YYYY Describe your illness and why you need a sick / fit note:Are you happy for us to send you your sick/fit note digitally? * Yes No