Sick Line Extension – Culloden Medical Practice

Please only use this form if you ALREADY have a sick line from us and have spoken to one of the GPs. This form is only for extending a current sickline. If you do not have a sick line, but feel you require one, please call us between 8-9am for an on the day appointment.

Telephone Number(Required)

How long does your certificate need extended for?(Required)

Reason for certificate (this will already be on your certificate unless you need this changed)(Required)

Would you like your certificate emailed or would you like to collect it?(Required)