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Fit/Sick Notes (Med3).

You can use the form below to make a request for a sick note. 

Once submitted we will contact you via email or telephone to let you know if the note has been completed and when you can collect. 

Please note that this is a request only, and not a guarantee that a sick note will be completed. We may need to discuss the request further, and you may be asked to make an appointment (telephone or in person) to discuss your request further. 

Request for a Sick Note (Med3)

Date of Birth
Day
Month
Year

First line of address only

Is this a new sick note or an extension to an existing sick note?
New
Extension

Please note we are unable to specify future starting dates on sick notes

Please let us know what illness is keeping you off work and any details that are important for us to know.

If this is a follow up sick note, it should be the same reason as the last sick note

How long would you like the sick note for? Please specify in days, weeks or months. Alternatively if you have specific date of return to work then please specify this.

Health Board

Cwm Taf Morgannwg University Health Board
Keir Hardie University Health Park
Aberdare Road
Merthyr Tydfil
CF48 1BZ

Phone: 01685 721721

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