Medical Letters & Certificates Request Form

Type of document requested

Please select the option that best describes your request.

Type of Medical Letter

Fit note for work absence£24.99

University Absence and Extenuating Circumstances (medical impact on attendance)£29.99

Standard Medical Letter (Factual confirmation of diagnosis and impact)£29.99

Supporting Formal Applications (DWP, PIP, ESA, Universal Credit, Housing etc.)£34.99

Court Letter (fitness to attend court, relevant medical explanation. £34.99

Fitness to Work £34.99

Fitness for Sporting Event£39.99

Fitness to Dive / Scuba Diving Certificate£39.99

Fitness To Travel£39.99

Personal details

Full Name

Date of Birth

Day

Month

Year

Email address

Mobile Number

Preferred method of contact

Email

Phone

You will be contacted by the doctor shortly after submitting your request

Request overview

Who is the letter addressed to? and for what purpose?

Do they have a specific form or require specific wording or a template?

No

Yes (please upload supporting document)

Describe your symptoms or medical condition

Briefly describe your symptoms, when they started, how they affected your ability to attend work/study, and whether you have seen a doctor or received any treatment or advice.

Current Medication

Are you currently taking any medication?

Yes (please provide brief details)

No

Details below. Alternatively you can upload pictures or screenshots of NHS App

Medical background

Do you have any long-term medical conditions?

Give as much details as possible including dates

Are you currently under the care of a GP or specialist in the UK?

Yes

No

Upload supporting documents

Upload any relevant documents

(Multiple uploads allowed)

GP summaries (or screenshots of NHS App GP records)
Clinic letters
Blood test results
Imaging reports (MRI/CT/Ultrasound)
Discharge summaries
Medication lists (or pictures of meds)
Photos of paper documents

Uploading supporting information may help us process your request more quickly.

I confirm that the information I have provided is accurate and truthful to the best of my knowledge.

I understand that medical letters are issued based on clinical judgment and review of the information provided.

I understand that:

The letter will be factual and clinically appropriate.
The doctor cannot guarantee acceptance by third parties.
False or misleading information may result in refusal of service.

I confirm and consent to remote assessment and document review.

Electronic Signature (type your full name)

Date

Day