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To make our website work efficiently and to provide our website visitors with a good experience when using the website, we use cookies. Cookies are small data files that are placed on your computer or mobile device when you visit a website. Consenting to cookies will allow us to process data such as browsing behaviour or unique IDs. We only share this data with organisations that provide services to the NHS. Not consenting or withdrawing consent to cookies may adversely affect certain features and functions of our website. Please also see the practice’s privacy policy as this may differ to the GPsurgery.net network privacy policy.

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Request a private GP letter

Fill in the form below to request a private GP letter.

First name(Required)

Surname(Required)

Date of birth(Required)

Day

Month

Year

Your current address(Required)

Contact number(Required)

Email(Required)

Enter Email Confirm Email

Reason for private letter request(Required)

To whom it may concern

Fit for Travel / Filming etc

For School or University

Fitness to attend a Gym

For Local Authority

Housing

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Other

Please provide more information about your request(Required)

Not for urgent medical help(Required)

Yes, I understand this form is NOT for urgent medical help

Consent(Required)

By submitting your details you are consenting to providing this information for improving our services to you. The data you supply on this form will be securely stored on our website, which is hosted by a third party. We will retain this information on the website for no longer than 7 calendar days. Your contact details will not be sold or shared with a third party. I understand I can revoke this consent at anytime by contacting the practice. Our privacy policy can be viewed on this website.

I agree to the privacy policy.

Date published: 21st November, 2023
Date last updated: 15th February, 2026

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