Padgate Medical Centre

Padgate Medical Centre, 12 Station Road South, Padgate, Warrington

Telephone: 01925 815333

CMICB-WAR.PadgateMC@nhs.net

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Request a Sick Note

Please be aware that this form can only be used for sick note requests. If you require medical attention then please call the surgery on 01925 815333 or use PATCHS here.

We are unable to pre-date sick notes so please only request your new note when the previous one has reached the end date. We can back date your sick note if required so you are still covered for everyday you are off sick.

If you have been off sick for less than 7 days then you must complete a self certificate form for the first week. You can complete a self certificate form here. If you are off sick for an extended period of time then please request a sick note below.

Request a sick note

Name(Required)
Date of birth(Required)
Address(Required)
Consent(Required)
Is this a request for a new sick note or an extension of an existing sick note?(Required)
What is the start date required for your note(Required)
What is the end date required for your note?(Required)
Privacy(Required)
This field is for validation purposes and should be left unchanged.

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