Letter request form

Letter request form

Who should the letter be addressed to?

For example, School, University, Work, Other Agencies

What is the reason for the letter?

Tell us the medical background to this request:

The doctor can only include factual information and cannot add personal statements or judgements. If the doctor needs clarification or cannot provide the requested information, they will contact you to explain what the letter can and can’t contain before proceeding.

Are there any specific dates that need to be mentioned?

Is there any specific information that must be mentioned in the letter?

When do you require the letter by?

Our standard timeframe for completing any private work is up to 30 days. If you need the information by a specific date, please let us know in advance. Please note that an additional fee may apply for urgent requests (within less than 7 days).

Please note: Private notes, certificates and letters fall outside the general medical services contract and are chargeable.

Please see Non-NHS work fees page for more information.

Confirmation

I understand that this is a request for non-NHS work and will incur a fee.

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