Letter/Report/Copy of medical record request

Please select one of the options below

TO WHOM IT MAY CONCERN LETTER/ EXTRACT FROM YOUR RECORDS (7 working days once payment is received) – £40. – A letter detailing your problems and any adverse effects that you may suffer from as a result of your condition.

REGISTRATION LETTER (7 working days once payment is received) – £40 – A letter noting the date you registered with the surgery.

COPY OF MEDICAL RECORDS (within 28 days) – free of charge

As you have selected:”COPY OF MEDICAL RECORDS” – PLEASE DO NOT COMPLETE THIS FORM. INSTEAD DOWNLOAD, COMPLETE AND DROP OFF THE FOLLOWING FORM FROM OUR WEBSITE, AT THE SURGERY.– You can collect this form from reception too. – https://www.enderley.nhs.uk/policies/access-to-records/

Alternatively, register for NHS App to access your medical records. https://www.enderley.nhs.uk/how-do-i-register-for-online-services/

First name

Last name

Date of birth

Organisation requesting letter* e.g. DWP, DVLA, Blue Badge, etc.

Please give us as much detail as possible of what you require to be included in the letter

The GP will only be able to write the letter based on the factual information available to us from your medical record.

Payment option

Via email (we will email you a Secure payment link)

Via SMS (we will text you the link)

In person (cash or card)

Contact number

Email address

PLEASE NOTE:

Doctors letters are NOT covered by the NHS and therefore a charge will apply for completing the above request. https://www.enderley.nhs.uk/health-information/fees-for-non-nhs-services/
We endeavour to complete your requested letter or report within 7 working days but this might not always be possible. This could be due to staff absences, busy periods or unforeseen circumstances. If a delay is encountered with your request, we will be in contact.

Please tick this box to confirm you are aware we are only able to prepare the letter based on the information we hold in your medical record.

Yes

Please tick this box to confirm you are aware it may take up to 7 working days to complete a routine request.

Yes

Please tick this box to confirm you are aware that we will not proceed with this request until payment is made.

Yes

Please tick this box to confirm you are happy to receive updates via email and/or SMS.

Yes

Please tick this box to confirm you are aware that if your email address and/or mobile number does not match the information we hold, you will need to collect the letter from the surgery with a valid photo ID.

Yes

Please tick here to confirm the above information is correct and you are happy for us to proceed once payment is made.

Yes

If you are human, leave this field blank.