Medical Report/ Private Work Request

Last Updated: 12/04/2024

Medical Report/Private work Request

The forms/Letter you're requesting fall outside the scope of the NHS contract, so our clinicians handle them as private work outside regular surgery hours. Typically, private work takes around 6-8 weeks for completion.

There's a set fee for this service, which needs to be paid upfront before commencement. You can find the detailed costs in the FEES FOR NON-NHS SERVICES List. Once we receive your request, your registered GP will review it. If they're unable to fulfil it, we'll inform you within 2 weeks and issue a refund if payment has been made.

Refunds are applicable only if we decline the work. If you believe there is an error in the work that we agreed to do and are seeking a refund, you will need to follow our complaints process for resolution.

Please note that we can't guarantee the success of your claim or appeal if you're using this information as support.

Full Name *

Date of Birth *

Phone Number *

Email Address *

Named GP (if known)

Report

What type of medical report would you like? *

To whom it may concern Letter

Occupational Health Advice

HGV/PSV Medicals

Taxi Medicals

Holiday Cancellation Form

Other

Details of Request

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA. *

I consent to the practice collecting and storing my data from this form.

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Medical Report/ Private Work Request

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