Request a private letter or form - Penarth Healthcare Partnership

The practice has a primary duty to provide services for the management of patients who are ill. Writing letters and reports (i.e. for insurance providers, adoption and fostering, driving (DVLA), housing and benefits appeals, schools, health clubs and employers) all fall outside of the NHS GP contract.

When medical reports are provided they are a private service and as such, have to be completed in the GP’s own time outside of their paid NHS working hours.

These services incur a fee and we set our fees with reference to the British Medical Association guidance on private fees.
View our fees

Please complete the form below, and we will advise you of the exact fee before processing your request.

About You

Name

Address

Date of Birth

Phone Number

Email Address

FURTHER INFORMATION

Reason for GP Private Letter Request (Practice Staff other than doctors or nurses will read this and there will be a charge for these requests)

To whom it may concern (Please provide more detail below)
Fit for Travel/Filming etc (Please provide more detail below)
For School or University (Please provide more detail below)
Fitness to attend a Gym (Please provide more detail below)
For Local Authority (Please provide more detail below)
Legal (Please provide more detail below)
Other (Please provide more detail below)

Please provide a reason for 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.

I consent to the practice collecting and storing my data from this form.

Yes