Medical Report Request

If you would like to request a medical report, please use this form.

If you are human, leave this field blank.

Which surgery do you normally attend?

East Harling Surgery

Kenninghall Surgery

Both

Section

Named GP (if known):

What type of medical report do you require? *

Please specify: *

Please state exactly what information you are requesting. We will aim to process your request within 28 days of receipt of your request.

Please note: You will need to bring photo ID when collecting your report. An extension of 2 months can be allowed if necessary, taking into account the complexity of the request. A fee can no longer be charged unless the request is manifestly unfounded or excessive, in which case a fee may be charged or the request refused.

Please specify: *

Why do you need this report? *

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Medical Report Request

Section

Are you in a mental health crisis?