Doctor's Letters

This form is to request letters from the surgery, which may often be subject to an administration fee.

Examples of letters:-

Housing Association
Bus Pass/Travel companion
Dietary needs for school
Travelling with medications/needles
Letter for employer for any reason

All of the above may take up to 28 days

Examples of things we do not do:-

Mental Capacity Assessment for legal reasons
Certificate Provider on Lasting Power of Attorney
Passport Verification
Witnessing Signatures

Please select the practice location most relevant to this Online Form submission:

Doctor's Letters

Name

Address

Telephone contact

Please let us know what you require - eg need to make a claim?

When is this request required by?

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Emsworth Medical Practice • North Street, Emsworth, Hampshire, PO10 7DD.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.