Private Service Request

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All questions marked with a * are mandatory

Image shows a letter being received

Private Services Requests 

Some letters, reports and forms requested by patients are not covered by NHS services and therefore attract a fee.

  • Please use this form to submit your request.

Important information:

  • Private work is not funded by the NHS and charges apply.
  • Fees must be paid before work commences unless otherwise agreed.
  • Submission of a request does not guarantee that a letter or report can be provided.
  • The GP will review each request individually.
  • Fees relate to the clinician's time reviewing records and preparing documentation.
  • Most requests are completed within 28 days.
  • A member of the practice team will contact you if payment is required or further information is needed.
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Personal Details
Please double check you've entered the correct email address

Help Us To Help You 

Providing a NHS Number means that we can find a patient record more accurately, saving time and resources. 

How to find your NHS Number 

Preferred Contact Method: *
Does this request involve any other family members?: *
Other Family Members

Help Us To Help You 

Providing a NHS Number means that we can find a patient record more accurately, saving time and resources. 

How to find your NHS Number 

Need to add another family member?: *

Help Us To Help You 

Providing a NHS Number means that we can find a patient record more accurately, saving time and resources. 

How to find your NHS Number 

Need to add another family member?: *

Help Us To Help You 

Providing a NHS Number means that we can find a patient record more accurately, saving time and resources. 

How to find your NHS Number 

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Details of Your Request

Important

Final fees may vary depending on complexity. The practice will contact you to confirm any payment required before work commences.

Recipient Details
Declaration

Important

  • Private services are not covered by NHS funding and therefore attract a charge.
  • Payment may be required before work commences.
  • The practice reserves the right to decline requests where a GP letter or report is not clinically appropriate.
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Privacy Consent

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Providing NHS Services

Contact

Woodlands Health Centre
4 Edwin Hall Place
Hither Green Lane
London
SE13 6RN

Telephone: 020 8698 6664

The Practice

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The Care Quality Commission Inspected and rated Good
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