top of page

D4 MEDICAL REQUEST FORM

Appointment type

In-person appointment

In-person appointment in Cambridge (CB24 8TX)
Do you already have a DVLA D4 form?
Yes, I will bring it
No. Please print one for me (extra £5)
Print a D4 Medical Form

Personal details

Date of Birth
Day
Month
Year

License details

Type of licence
Is this your first Group 2 medical?

Medical screening

Do you have or had any of the following conditions: - Diabetes - High Blood Pressure - Heart condition - Stroke - Epilepsy - Sleep Apnoea - Liver, kidney or lung/ respiratory disease

Add anything you feel we should be aware of or any questions you have

Preferred Date and Time

Subject to availability. We will contact you shortly after your submission to confirm.

For SAME DAY or NEXT DAY appointments or HOME VISIT

please message or call us (Directly or via WhatsApp)

07802782563

Please bring your GP medical records on the day of your D4 medical.

This can be via the

  • NHS App (GP Health Record) or

  • A printed GP medical summary from your surgery.

Tip: If you do not currently have access via the NHS App, contact your GP surgery reception a few days in advance to request a medical summary.

Do you have your GP records printed or in the NHS App?
I have printed GP Records
I have GP records on NHS App
Date
Day
Month
Year

Clarity Medicine

Dr Ali Khalil MBChB
GMC Registered Doctor

GMC No: 6137333

 

Independent Private Services
Cambridge, United Kingdom

info@claritymedicine.co.uk

Mobile / WhatsApp: +447802782563

 

Privacy Policy | Terms & Conditions | Disclaimer

Clarity Medicine provides independent private medical assessments and documentation. Services do not replace NHS GP care.

 

Clarity Medicine is a trading name of Pharmedical Ltd, registered in England and Wales.
Company number: 14719215
VAT number: GB 4864055567

© 2026 Clarity Medicine

bottom of page