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ALL certificate requests between 10th-12th June 2024 will be processed on the 13th June 2024.

Medical Letter Questionnaire

Before releasing your medical letter, our group of practitioners will review the evidence you submit. Only upon approval, shall you receive the medical letter via email including a unique reference number, which can be used to confirm its authenticity


I am in need of a Medical Letter regarding: Sports Consultation and Fitness Certificate
Your Details
Full Name *
Email *
Mobile Number *
Date of birth *
Sex *

GP Details

Do we have permission to write to your usual GP with the results of this medical if necessary? *
Registered GP's Full Name

Registered GP's Address

Registered GP's Telephone Number

Registered GP's E-mail

Have you consulted your GP for any health related issues in the the past 3 years? *
If yes, please describe

Medical History

Height *

In cm

Weight *

In Kg

What is your Body Mass Index (BMI)? *

.

What was your last blood pressure reading? *

.

When was your most recent blood pressure reading taken? *

Have you ever suffered from any of the following diseases?

High blood pressure *
Cardiac Arrythmias or Palpitations *
Stroke *
Heart Attack *
Asthma *
Bronchitis *
Any Type Of Chronic Disease *
Rheumatic Fever *
Diabetes *
Epilepsy *
Thyroid Disease *
Bleeding Disorders Such As Haemophilia *
Heat Stroke *
Water Intoxication *
Any Other Medical Disorder *
If yes, please describe

Heart Disease

Have you any previous history of heart disease? *
If yes, please describe

Is there any family history of sudden cardiac death in close relatives (brothers, sisters, parents) under 50 years of age? *
If yes, please describe

Do you suffer from or have you suffered with chest pains and/or tightness when exercising? *
If yes, please describe

Do you suffer from or have you suffered with excessive breathlessness or wheeze when exercising? *
If yes, please describe

Do you suffer from or have you suffered with dizziness when exercising? *
If yes, please describe

Have you ever suffered from dizziness when not exercising? *
If yes, please describe

Do you suffer from or have you suffered from palpitations (a very fast or skipped heart beat) when exercising? *
If yes, please describe

Have you ever collapsed or lost consciousness whilst at rest or exercising? *
If yes, please describe

Current Medications

Are you currently on any medication? *
If Yes, please list all medications that you are on:

Have you been admitted to hospital for any reason in the past 3 years? *
If yes, please describe

Training and Preparation

Have you been training and plan to train in an adequate fashion to attempt a sporting event? *
How far are you cycling, running or swimming each week?

How long do you push your heart rate to 70% of its maximum for? *

Please indicate how many minutes or write that “I don’t know”

Have you completed any entrance events before? *
If yes, please describe (events details)

Have you ever fainted? *
If yes, please describe

How much do you smoke?

cigarettes per day

How many units of alcohol do you drink in a typical week?

units per week

Are there any other medical issues that we need to be aware of?
If yes, please describ (medical issues)

Have you ever taken performance enhancing drugs? *
If yes, please describe

Have you ever taken steroids to improve sporting performance? *
If yes, please describe

Have you ever been refused medical insurance? *
If yes, please describe

Please list the events you are entering over the next 12 months.

You will be provided with our generic medical certificate if you have not requested a specific format. If any of your events require a specific certificate template or form, please indicate in this section and upload the required template. We will issue a signed, stamped and dated medical certificate valid for 12 months from approval.

Supporting Information

Is there any other relevant information or specific requirements related to your athletic goals or participation that you would like to share with the GP?

Identification Upload - Please upload a scanned copy or clear image of your identification (e.g., passport, driver's license) for verification purposes.
Browse Files
Click here to upload file
If you need us to complete a form please use the option below to upload it.
Browse Files
Click here to upload file

Checkout

If your Partner Practitioner determines that telehealth is not appropriate for your case, you will be refunded.

Priority options: *

STANDARD REQUEST

This will be reviewed, signed by a UK health practitioner and sent via email.

£59.00
RECOMMENDED EXPRESS REQUEST

This will be reviewed, signed by a UK health Practitioner, and sent via email. Typically, you can expect to receive it within the same day.

£69.00

Confirm your details

Please double check your details below. These will appear on the medical letter, if suitable, and can't be edited after submission.


Name:
Date of birth:
Sex:
Male
Email:
Mobile:
Letter type:
Sports Consultation and Fitness Certificate

Terms

Upon submitting your medical consultation, you acknowledge our Terms and Privacy Policy and consent to the following:

  • You are NOT seriously unwell with any of the following symptoms: chest pain, shortness of breath, unable to swallow fluids or saliva, weakness or numbness down one side, slurred speech.
  • You have comprehended the questions in the questionnaire and answered them honestly.
  • The requested letter is solely for the individual with the provided name and details.
  • The GP Clinic is not a replacement for a doctor's visit, nor is The GP Clinic your primary doctor or GP, and your Partner Practitioner may be unable to access your NHS or regular GP medical records.
  • The GP Clinic facilitates access to private medical letters and does not issue Med3 notes, which are obtainable through your NHS GP for UK government benefits.
  • The GP Clinic cannot complete additional forms requested by your workplace, educational institution, or any other interested party.
  • If your symptoms persist or you have not fully recovered, you agree to consult with your regular doctor or GP for further medical advice.
  • The GP Clinic is unable to process refunds once our GP has reviewed your request and you've been sent a letter written by them. No exceptions.
Do you agree to the above Terms? *

Coupon Code

Subtotal $0
Discount $0.00
Hard Copy $0.00
Total $0.00

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