Request a Private Report

Page {{ paginatorProps.current }} of {{ paginatorProps.total }} ({{ paginatorProps.percentage }}% completed)
Personal Details
Please double check you've entered the correct email address
May be used to identify you
Details of your request
Only following file extensions are allowed: jpg, jpeg, png, webp, pdf, doc, docx, pptx
Please note that reports are not considered medically urgent and need to be done in doctors own time
  • Requests take up to 10 working days to process following payment.
  • Cost for a simple straightforward letter starts from £40.00 – if the letter is complex and requires other documents to be printed off there will be an additional time & cost.
  • For all other private reports/medicals please see the list of fees attached.  
  • If an amendment to the original letter is required there will be an additional charge of £10
  • Payment will be taken before the letter/report is completed and is non-refundable.  Cash, Card or BACS payments will be accepted.
Signature

Privacy Consent

This form collects personal and medical informanot tion about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
Previous Page  
Processing

There appears to be a problem loading the form, please refresh the page.
If the error persists please contact us.