Unity Health

Kimberlow Hill Surgery | Wenlock Terrace Surgery

Self Certification For Sickness Absence

Up to and including 6 days (Sundays do not count)

Doctors Details

I certify that the above absence was wholly due to sickness, industrial injury or accident and I claim any payment due to me under the sick pay arrangements.

I understand that should I make any false statements in completing this form I am liable to be dealt with under the disciplinary procedures.

I consent to my doctor being approached and/or to undergo a medical examination if the Practice considers this necessary.