Example of a sick note that
can also double as a general note or referral letter. |
| |
This is to confirm
that Prof / Dr / Mr / Mrs / Ms / Miss / Mast
___________________________________________________________________
Has been under my care from the / examined by me on
the:
Has been under the care / examined by my associate
on the:
___________________________________________________________________
Suffering from / relating to / reported to have had
___________________________________________________________________
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and that he / she...
- Will be fit to resume work / school / duty on the:
- Was too ill to write his / her exam on the:
- Is in good health and free of contagious diseases
- Is in good health and may travel by plane
- Is in good health and may go scuba diving
- Is in good health and fit for employment
- Is in good health and may go motor racing
- Has a medical condition that requires the following
travelling arrangements:
- Is currently taking the following prescription medication:
- Needs to be referred to the following therapist
/ specialist:
- May only resume sport / physical training / on the:
- None of the above, but with the following recommendations:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
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