Letter Request Form

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Personal Details
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Letter Request

Please provide as much detail as possible, tell us what you require to be included in the letter. Please note the doctor will only be able to write the letter based on the factual information available to us from your medical record.

Proof of Address and Photo ID Information

Proof of Address & Photo ID

In order for the practice to process your request for a letter, we require a proof of address (e.g.Tenancy agreement, council tax bill, utility bill or bank statement) and Photo ID ( e.g Passport or Driving licence). Please attach the proof of address and Photo ID as directed.

The practice policy for completing a routine letter request is 10 days. Please be aware that we will require proof of ID and payment prior to releasing the letter. There is an additional charge for letters that are requested on an urgent basis. See our non-NHS fees.

Signature

Privacy Consent

This form collects personal and medical information 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.

 
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