Application for Non-NHS Doctors Letter

All the information you need to know and how to request a letter.

You have requested that the surgery provides you with a private letter. To help you get the letter that you need we would be most grateful if you could complete the application form on the following pages.

The provision of private letters is not covered on the NHS. It is private work, and just like private work from a solicitor or any other professional, there is a charge for this work.

From the day the surgery receives your application, it will take ten working days to complete your letter ready for collection. This is because time completing forms takes the GP away from the care of his/her patients and meeting medical needs is obviously the priority. Please complete the application fully so we can provide you with the letter you require.

If you request that the letter is completed by a specific doctor who is away from the surgery or is on holiday it may take longer.

If you require the letter sooner, we will try to arrange this but it will be subject to the other demands of the practice, and will be subject to an additional charge and may not be possible to do at all times.

An indication of charges can be found as an additional page within this application. These fees will be reviewed on a yearly basis.

The surgery may be able to confirm the charge when you drop in your completed application but in most instances, the doctor must review the application before we can inform you what the charge will be.

A deposit of £10 will need to be paid before the application is processed. The balance will need to be paid before the letter can be collected. This can be done via paying by cash or cheque (payable to Eve Hill Medical Practice) within the surgery or via bank transfer. To do this by bank transfer please submit the form and we will send you a response with the bank details.

Please view our Non-NHS Work Fees for information about prices.

Application for Non-NHS Doctors Letter

About You

Please use format: example@mail.com
Is this letter about you (the person named above) or about someone else? *

If This Letter Is About Someone Else

To Be Completed By The Person Who The Letter Is About

Consent: *
Please select: *

About The Letter

Please note, the doctor will review your medical records when completing this letter. They will only be able to include factually accurate information that is included in your medical records. Unfortunately we cannot add information to the letter that is not in your medical records.

Declaration

Declaration *
Please select: *
Please upload any relevant document if you think it would help.
Maximum upload size: 67.11MB