diff --git a/plugins/node/opentelemetry-instrumentation-fastify/README.md b/plugins/node/opentelemetry-instrumentation-fastify/README.md
index 89c4a6e1d0..3e74f96b8b 100644
--- a/plugins/node/opentelemetry-instrumentation-fastify/README.md
+++ b/plugins/node/opentelemetry-instrumentation-fastify/README.md
@@ -45,6 +45,28 @@ registerInstrumentations({
 
 See [examples/fastify](https://github.com/open-telemetry/opentelemetry-js-contrib/tree/main/examples/fastify) for a short example.
 
+## Fastify Instrumentation Options
+
+| Options | Type | Example | Description |
+| `requestHook` | `FastifyCustomAttributeFunction` | `(span, requestInfo) => {}` | Function for adding custom attributes to Fastify requests. Receives params: `Span, FastifyRequestInfo`. |
+
+### Using `requestHook`
+
+Instrumentation configuration accepts a custom "hook" function which will be called for every instrumented Fastify request. Custom attributes can be set on the span or run any custom logic per request.
+
+```javascript
+import { FastifyInstrumentation } from "@opentelemetry/instrumentation-fastify"
+
+const fastifyInstrumentation = new FastifyInstrumentation({
+  requestHook: function (span: Span, info: FastifyRequestInfo) {
+    span.setAttribute(
+      'http.method',
+      info.request.method,
+    )
+  }
+});
+```
+
 ## Useful links
 
 - For more information on OpenTelemetry, visit: <https://opentelemetry.io/>
diff --git a/plugins/node/opentelemetry-instrumentation-fastify/package.json b/plugins/node/opentelemetry-instrumentation-fastify/package.json
index 915fcda542..71b0a1b843 100644
--- a/plugins/node/opentelemetry-instrumentation-fastify/package.json
+++ b/plugins/node/opentelemetry-instrumentation-fastify/package.json
@@ -54,8 +54,8 @@
     "@types/express": "4.17.13",
     "@types/mocha": "7.0.2",
     "@types/node": "18.11.7",
-    "gts": "3.1.0",
     "fastify": "^4.5.3",
+    "gts": "3.1.0",
     "mocha": "7.2.0",
     "nyc": "15.1.0",
     "rimraf": "3.0.2",
diff --git a/plugins/node/opentelemetry-instrumentation-fastify/src/index.ts b/plugins/node/opentelemetry-instrumentation-fastify/src/index.ts
index 34b600dd0c..958c8fef60 100644
--- a/plugins/node/opentelemetry-instrumentation-fastify/src/index.ts
+++ b/plugins/node/opentelemetry-instrumentation-fastify/src/index.ts
@@ -15,4 +15,5 @@
  */
 
 export * from './enums/AttributeNames';
+export * from './types';
 export * from './instrumentation';
diff --git a/plugins/node/opentelemetry-instrumentation-fastify/src/instrumentation.ts b/plugins/node/opentelemetry-instrumentation-fastify/src/instrumentation.ts
index 4f6df78268..94b4feb035 100644
--- a/plugins/node/opentelemetry-instrumentation-fastify/src/instrumentation.ts
+++ b/plugins/node/opentelemetry-instrumentation-fastify/src/instrumentation.ts
@@ -23,7 +23,6 @@ import {
 import { getRPCMetadata, RPCType } from '@opentelemetry/core';
 import {
   InstrumentationBase,
-  InstrumentationConfig,
   InstrumentationNodeModuleDefinition,
   safeExecuteInTheMiddle,
 } from '@opentelemetry/instrumentation';
@@ -39,6 +38,7 @@ import {
   FastifyTypes,
 } from './enums/AttributeNames';
 import type { HandlerOriginal, PluginFastifyReply } from './internal-types';
+import type { FastifyInstrumentationConfig } from './types';
 import {
   endSpan,
   safeExecuteInTheMiddleMaybePromise,
@@ -50,7 +50,7 @@ export const ANONYMOUS_NAME = 'anonymous';
 
 /** Fastify instrumentation for OpenTelemetry */
 export class FastifyInstrumentation extends InstrumentationBase {
-  constructor(config: InstrumentationConfig = {}) {
+  constructor(config: FastifyInstrumentationConfig = {}) {
     super(
       '@opentelemetry/instrumentation-fastify',
       VERSION,
@@ -58,6 +58,14 @@ export class FastifyInstrumentation extends InstrumentationBase {
     );
   }
 
+  override setConfig(config: FastifyInstrumentationConfig = {}) {
+    this._config = Object.assign({}, config);
+  }
+
+  override getConfig(): FastifyInstrumentationConfig {
+    return this._config as FastifyInstrumentationConfig;
+  }
+
   init() {
     return [
       new InstrumentationNodeModuleDefinition<any>(
@@ -271,6 +279,19 @@ export class FastifyInstrumentation extends InstrumentationBase {
         spanName,
         spanAttributes
       );
+
+      if (instrumentation.getConfig().requestHook) {
+        safeExecuteInTheMiddle(
+          () => instrumentation.getConfig().requestHook!(span, { request }),
+          e => {
+            if (e) {
+              instrumentation._diag.error('request hook failed', e);
+            }
+          },
+          true
+        );
+      }
+
       return context.with(trace.setSpan(context.active(), span), () => {
         done();
       });
diff --git a/plugins/node/opentelemetry-instrumentation-fastify/src/types.ts b/plugins/node/opentelemetry-instrumentation-fastify/src/types.ts
new file mode 100644
index 0000000000..2deadc0598
--- /dev/null
+++ b/plugins/node/opentelemetry-instrumentation-fastify/src/types.ts
@@ -0,0 +1,39 @@
+/*
+ * Copyright The OpenTelemetry Authors
+ *
+ * Licensed under the Apache License, Version 2.0 (the "License");
+ * you may not use this file except in compliance with the License.
+ * You may obtain a copy of the License at
+ *
+ *      https://www.apache.org/licenses/LICENSE-2.0
+ *
+ * Unless required by applicable law or agreed to in writing, software
+ * distributed under the License is distributed on an "AS IS" BASIS,
+ * WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied.
+ * See the License for the specific language governing permissions and
+ * limitations under the License.
+ */
+
+import { Span } from '@opentelemetry/api';
+import { InstrumentationConfig } from '@opentelemetry/instrumentation';
+
+export interface FastifyRequestInfo {
+  request: any; // FastifyRequest object from fastify package
+}
+
+/**
+ * Function that can be used to add custom attributes to the current span
+ * @param span - The Fastify handler span.
+ * @param info - The Fastify request info object.
+ */
+export interface FastifyCustomAttributeFunction {
+  (span: Span, info: FastifyRequestInfo): void;
+}
+
+/**
+ * Options available for the Fastify Instrumentation
+ */
+export interface FastifyInstrumentationConfig extends InstrumentationConfig {
+  /** Function for adding custom attributes to each handler span */
+  requestHook?: FastifyCustomAttributeFunction;
+}
diff --git a/plugins/node/opentelemetry-instrumentation-fastify/test/instrumentation.test.ts b/plugins/node/opentelemetry-instrumentation-fastify/test/instrumentation.test.ts
index aa17f3b246..d80595728a 100644
--- a/plugins/node/opentelemetry-instrumentation-fastify/test/instrumentation.test.ts
+++ b/plugins/node/opentelemetry-instrumentation-fastify/test/instrumentation.test.ts
@@ -24,6 +24,7 @@ import {
   ReadableSpan,
   SimpleSpanProcessor,
 } from '@opentelemetry/sdk-trace-base';
+import { Span } from '@opentelemetry/api';
 import { HookHandlerDoneFunction } from 'fastify/types/hooks';
 import { FastifyReply } from 'fastify/types/reply';
 import { FastifyRequest } from 'fastify/types/request';
@@ -31,6 +32,7 @@ import * as http from 'http';
 import { HttpInstrumentation } from '@opentelemetry/instrumentation-http';
 import { ANONYMOUS_NAME } from '../src/instrumentation';
 import { AttributeNames, FastifyInstrumentation } from '../src';
+import { FastifyRequestInfo } from '../src/types';
 
 const URL = require('url').URL;
 
@@ -426,5 +428,71 @@ describe('fastify', () => {
         await startServer();
       });
     });
+
+    describe('using requestHook in config', () => {
+      it('calls requestHook provided function when set in config', async () => {
+        const requestHook = (span: Span, info: FastifyRequestInfo) => {
+          span.setAttribute(
+            SemanticAttributes.HTTP_METHOD,
+            info.request.method
+          );
+        };
+
+        instrumentation.setConfig({
+          ...instrumentation.getConfig(),
+          requestHook,
+        });
+
+        app.get('/test', (req, res) => {
+          res.send('OK');
+        });
+
+        await startServer();
+        await httpRequest.get(`http://localhost:${PORT}/test`);
+
+        const spans = memoryExporter.getFinishedSpans();
+        assert.strictEqual(spans.length, 5);
+        const span = spans[3];
+        assert.deepStrictEqual(span.attributes, {
+          'fastify.type': 'request_handler',
+          'plugin.name': 'fastify -> @fastify/express',
+          [SemanticAttributes.HTTP_ROUTE]: '/test',
+          [SemanticAttributes.HTTP_METHOD]: 'GET',
+        });
+      });
+
+      it('does not propagate an error from a requestHook that throws exception', async () => {
+        const requestHook = (span: Span, info: FastifyRequestInfo) => {
+          span.setAttribute(
+            SemanticAttributes.HTTP_METHOD,
+            info.request.method
+          );
+
+          throw Error('error thrown in requestHook');
+        };
+
+        instrumentation.setConfig({
+          ...instrumentation.getConfig(),
+          requestHook,
+        });
+
+        app.get('/test', (req, res) => {
+          res.send('OK');
+        });
+
+        await startServer();
+        await httpRequest.get(`http://localhost:${PORT}/test`);
+
+        const spans = memoryExporter.getFinishedSpans();
+        assert.strictEqual(spans.length, 5);
+        const span = spans[3];
+        assert.deepStrictEqual(span.attributes, {
+          'fastify.type': 'request_handler',
+          'plugin.name': 'fastify -> @fastify/express',
+          [SemanticAttributes.HTTP_ROUTE]: '/test',
+          [SemanticAttributes.HTTP_METHOD]: 'GET',
+        });
+      });
+    });
   });
 });