Letter Request

This form is for letter requests only. If you need a report/medical or form completed by a doctor please complete our medical report request form.

If you would like to request a doctors letter, please use this form. Please provide as much information as possible. If we do not have sufficient information the Doctor may not be able to continue with your request. 

Doctor’s letters are non NHS work and so do not take priority over patients care.

 

The charge for this non NHS service is £25.

 

Please note as this is non NHS work your request may take up to 4 weeks to complete. You will be notified when your request is complete, and payment will be due upon collection.

  • Your Details

    Date of Birth
    For example, 15 3 1984

  • Recipient Details

  • Context of Request

    E.g. Housing letter, letter for employer, proof of registration for bank, proof of medical conditions

    Please provide as much information as possible. If we do not have sufficient information the Doctor may not be able to continue with your 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.
The information you provide on this form will be sent to our practice and used only to deal with your request. Depending on the form, this may include your contact details, personal information and health information. The practice may add it to your medical record and, where needed for your care, share it with other NHS and care services. To find out how we protect and use your information, please read our privacy policy on our website.
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Page last reviewed: 22 December 2025
Page created: 02 November 2026