Request a Letter

If you would like to request a letter, please use this form.

Request a Letter

Patient Details

Please use this date format: DD/MM/YYYY. Your date of birth is required to verify your identity.
This email address will be used for all correspondence relating to this request. Please be aware that if anyone else has access to this email address that they may see responses sent to you.

Letter 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.

If not known, please leave blank.

Letters are not part of the NHS so there is a charge to pay for GP and secretary time. The charge is £20, but it could be more if the letter is longer. Letters will not be created until the payment has been received. Please call the practice to make a payment, after you have submitted this form.

Checkboxes *