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Medical report request

Medical Report Request
Required fields are labelled
Who are you completing this form for?
For example, on behalf of a child or dependent
What is your name?
What is your date of birth?
For example, 31 3 1980
What is your sex?
As recorded on your medical record
The one used to register with your GP
Anyone else with access to your email account may see responses sent to you
What type of medical report do you require?

Please note that private work can take up to 4 weeks to complete. Medical records need to be checked prior to release and this can take a minimum of 4 weeks.

Please note that if you need your request sooner than 4 weeks this may not be achievable.

We may contact you if we need more details to complete your request. Please select your preferred contact method:
Confirmation
Enter full name
Please use this date format: DD/MM/YYYY.