Medical Request, Reports & Letters

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

If you would like to pay for your medical, report or letter via online banking please do so with the details below:

Mundesley Medical Services Details for BACS Transfer

Account Name: Mundesley Medical Services Ltd
Sort Code: 30-96-17
Account Number: 04083445

Claiming for Personal Independence Payment (PIP)

Please visit www.GOV.UK/PIP so you can consider if you eligible prior to claiming.

The PIP pages include easy-read guides and links to YouTube videos about eligibility, evidence requirements and the claims process. These will help individuals to consider whether PIP is the right benefit for them and understand what supporting information they need if they decide to claim.

Medical Request, Reports & Letters

Medical Request, Reports & Letters

Section

What do you require? *
Please select the appropriate certificate(s) you require: *
Please select the appropriate letter: *

*
By completing, you confirm that the letter provided will only be used for the reason stated in this field
Please provide name and address.
Please use the format DD/MM/YYYY.

Standard letters cost £20 which is required in advance. However, an additional charge will be made if excess information is required or an appointment is required.

What format would you like this provided to you in: *
Is there a specific clinician that you would like to provide the letter? Please note this may delay the letter if the clinician is unavailable:

Many thanks for this information, if we require anything further we will get in contact with yourself.

In the meantime we will put at invoice at the front desk for you to pay. If for any reason the clinician is unable to do the letter, we will contact you and issue a full refund.

We aim to complete these requests in 3 working days from the date of payment.

Please select the appropriate report(s) you require: *
Please specify if you would like the following with the employer's report & opinion (with examination):
Please specify if you would like the following with the life insurance report:
Please specify if you would like the following with the Court of Protection/Power of Attorney Certificate:
Please select the appropriate medical(s) you require: *

Expedite Request

Do you have any new symptoms? *
Have your symptoms worsened? *
Are your symptoms affecting your activities of daily living? *

Due to answering no to the above questions, we are unable to process an expedite request as there has to be a clinical need to do so.

If you have provided medical reasons please be aware that we will process this request and send it onto the hospital, but it is the consultants at the hospital who make the final decision, so there is a chance this expedite request will be rejected.