Non-NHS Services

What is a Non-NHS Service Request?

When your doctor is asked to give medical information about you in the form of a private report, letter or certificate – it is deemed as ‘non-NHS work’ which is not covered by the NHS GP contract. The process is explained below, and requires a fee to be paid to cover the time & costs for completing the work, away from routine NHS work.

How to Make a Non-NHS Service Request for Yourself

We require proof of your identity before we can disclose personal data. This should include copy of document such as:

• Passport
• UK Driving License (full or provisional)
• European driving licence (full)
• European national identity card
• UK residence card or biometric residence permit (BRP)
• Birth certificate
• Marriage or civil partnership certificate
• NHS England identity badge

The documents should include your name, date of birth and current address. If you have changed your name, please supply relevant documents evidencing the change.

Please submit the request via our online form. You will also need to include copies of information that confirms your identity.

How to Make a Request for Someone Else

You can apply as a third party for someone that you are responsible for, including for a child, or for someone who has died. You will need to provide proof that you are allowed to act on their behalf. Health records are confidential so you can only access someone else’s records if you are authorised to do so.

Advice for Sending Requests to the Team

Due to the sensitive nature of the information needed to process your request, it would be preferable for us to receive your application via our secure online form, rather than via email and post.

If you are unable or do not have access to internet, you may submit a written request.
Thank you for your support and understanding.

No Refund Policy

Please be advised that our Practice has a no refund policy for such items of work.

The practice takes significant time and effort to process and action your request outside of their usual NHS duties. This time is accounted for in the fees, and therefore, once the practice starts any work on your request, a refund cannot be issued. By submitting a request for private work, you are confirming the nature of the work you require, and that you accept the no refund policy.

Amendments Policy

Amendments to Non-NHS letters or reports may be possible, but additional fees will apply.

If you would like changes made to a Non-NHS letter or report, the practice will review your request to decide if the amendments are appropriate. Where amendments are possible, an additional fee will apply to cover the time and costs involved. We will always confirm this fee with you in advance, and payment will be required before the amended document can be issued.

Incomplete Applications

Incomplete applications will be returned, therefore, please ensure you have the correct documentation before returning the form.

Our Response

We will usually process your request within 30 days. As long as we have received proof of your identity, payment of the fee, and the work reflects what the GP knows to be true based on your medical records.

Following your request, we may write back to you within the 30-day time frame to request you to clarify or modify your request, based on our review of the request. This may also result in an extension of up to 60 days whilst we examine your request.

Information is provided in line with the General Data Protection Regulations (GDPR), Chapter 3, Article 15 (Recitals 63 & 64).

Non-NHS Services Request Form

Email  Optional

This field is for validation purposes and should be left unchanged.

Please tick the relevant boxes below. Accurate selection, will help avoid delays in processing your request.

DVLA, TFL/Taxi Cab, HGV examination/report £145.00

If the DVLA requests further Information, there may be an additional fee; starting from £25.00

Firearms Licence - (Depending On Level Of Work Required) Starting From £50

Fitness To Fly - Pregnant Woman. From £40.00

Fitness To Travel Short Certificate - Existing Health Conditions. From £40.00

Fitness To Travel Examination & Report £70.00

Private Letter Relating To Flights / Travel With Medicines. From £40.00

Freedom From Infection - Travel, School, Employment £45.00

Insurance Claim Form Completion - (Depending On Level Of Detail) Starting From £40

Insurance Claim Form Additional Information (Depending on Level of detail) Starting from £30

Private Prescription £20.00

Private Sick Certificate (Statement of diagnosis) £30.00

Other Private Letters - (Depending On Level Of Detail) Starting From £40

Private Letter For Absence from Work £50.00

Private Letter For School, University Exams £60.00

Private Letter - Full Medical History £75.00

Confirmation of Patient Registration £30.00 (+ £10 per additional household member)

Travel Vaccination Certificate £30.00

Travel Cancellation. From £40.00

Mental Capacity Assessment (Consultation + Report). £150

Vaccinations (non-NHS)

Hepatitis B (Travel) - 3 Doses £170.00  Optional

Japanese Encephalitis - 2 Doses £190.00  Optional

Rabies - 3 Doses £185.00  Optional

Meningitis ACWY £70.00  Optional

Tick Borne Encephalitis - 3 Doses £140.00  Optional

Please specify the reason for requesting a letter. If related to a specific injury, please provide dates of injury/hospital attendance.

First Name

First

Last Name

Last

Date of Birth

DayDay12345678910111213141516171819202122232425262728293031

MonthMonth123456789101112

YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Address

Street Address City Postcode

Phone Number

Email

If request is for more than one person then please list the above details for each additional person  Optional

Are you the Patient

Yes

No

Please complete if you are requesting access on behalf of the above-named patient

First Name

First

Last Name

Last

Phone Number

Email

Address

Street Address City Postcode

Relationship to the patient

Proof of identity   Patients will be asked to provide 2 forms of identification one of which must be photographic identification. Please speak to reception if you are unable to provide this. Countersignature will be accepted only in exceptional circumstances.  

Consent for children   If a child aged 13 or over has “sufficient understanding and intelligence to enable him/her to understand fully what is proposed” (known as Gillick Competence), then she/he will be competent to give consent for him/herself. They may wish a parent to countersign as well. Young people aged 16 and 17 are legally competent and may therefore sign this consent form for themselves but may wish a parent to countersign as well. If the child is under 18 and not able to give consent for him/herself, someone with parental responsibility may do so on his/her behalf by signing this form below.

Timeframe for responding to requests   In accordance with the UK GDPR, patients are entitled to receive a response within the maximum given time frame of one calendar month from the date of submission of the request. To ensure full compliance regarding Private Work, this organisation will adhere to the guidance provided in the UK GDPR. In the case of complex or multiple requests, the data controller may extend the response time by a period of two months. In such instances, the applicant must be informed in the first month and the reasons for the extension given. Should the request involve a large amount of information, the data controller will ask the data subject to specify what data they require before responding to the request. Data controllers are permitted to “stop the clock” in relation to the response time until clarification is received. Incomplete applications will be returned; therefore, please ensure you have the correct documentation before returning the form. You will be telephoned when the letter / document is ready for collection or posting.

No Refund Policy   Please be advised that Colindale Medical Centre has a no refund policy for such items of work. The practice takes significant time and effort to process & action your request outside of their usual NHS duties. This time is accounted for in the fees, and therefore, once the practice starts any work on your request, a refund cannot be issued. By submitting a request for Private (Non-NHS) services you are confirming the nature of the work you require, and that you accept the non-refund policy.

Patient Signature

I confirm that I give permission for the Organisation / Parent to communicate with the person identified above regarding my medical records

Applicant Signature

Patient Signature

Countersignature

This is to be completed by someone (other than a member of your family) who can vouch for your identity. This section may be completed if proof of identity cannot be fulfilled.

First Name

First  Optional

Last Name

Last  Optional

Phone Number  Optional

Email  Optional

Address

Street Address  Optional City  Optional Postcode  Optional

Relationship to Patient  Optional

I certify that the applicant is known to me personally and that I have witnessed the signing of the above declaration. I am happy to be contacted if further information is required to support the identity of the applicant as required.

Date

Day  OptionalDay12345678910111213141516171819202122232425262728293031

Month  OptionalMonth123456789101112

Year  OptionalYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Applicant signature  Optional

Date

Day  OptionalDay12345678910111213141516171819202122232425262728293031

Month  OptionalMonth123456789101112

Year  OptionalYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Patient Signature  Optional

Upload any supporting documents if required  Optional

Max. file size: 128 MB.

To allow your request to be processed smoothly please upload the required documents