Non-NHS services request

The NHS does not pay for some of the services we provide. These include private sick notes, insurance forms, holiday cancellation forms, medical reports, fitness to travel certificates, private prescriptions, passport signing and some vaccination services. Our fees for these services are displayed in the surgery.

The fees charged are based on the British Medical Association (BMA) suggested scales and our reception staff will be happy to advise you about them along with appointment availability.

Turnaround time for all Non-NHS services fee requests is 28 days.

Complete the form below to make a non-NHS service request.

Name

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

Non-NHS service

Please choose items from the drop-down non-NHS service fees list(Required)

Your details

Name(Required)

First name(s) Last name

Date of birth

Email(Required)

Enter Email Confirm Email

Contact telephone number(Required)

Confirmations and further comments

Please tick box to confirm you accept the fee shown in the drop-down menu above(Required)

Yes I accept the fee shown

Please tick box to confirm you accept the 28-day turnaround(Required)

Yes I accept the 28-day turnaround

Please add any further comments that you believe will assist with your request

Sending forms or documents through for completion

Please send any forms or documents necessary to complete your request by email ([email protected]) or leave at the Surgery Reception as soon as possible.

Completion of your Non-NHS Service Request

An email or SMS will be sent directly once your request has been completed. Payment in full is required before any completed forms/letters are presented.

Not for urgent medical help(Required)

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

Date published: 16th January, 2026
Date last updated: 1st April, 2026