Vaccine Exemption Certificate Questionnaire

Medical History

Have you experienced any severe allergic reactions (anaphylaxis) to vaccines or vaccine components in the past? *

Yes No

Do you have a history of severe immune system disorders or immunodeficiency conditions? *

Yes No

Have you previously experienced adverse reactions to vaccines? *

Yes No

Are you currently taking any medications or treatments that may affect your ability to receive vaccines? *

Yes No

Priority options: *

STANDARD REQUEST

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

£45.00

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.

£55.00

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:

Vaccine Exemption 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.
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? *

Agree

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The GP Clinic

Medical Letter Questionnaire

Medical History

Specific Vaccine Information

Current Health Status

Consultation with a Specialist

Additional Information

Checkout

Priority options: *

Confirm your details

Terms

Do you agree to the above Terms? *

Coupon Code

Medical Letter Questionnaire

Medical History

Specific Vaccine Information

Current Health Status

Consultation with a Specialist

Additional Information

Checkout

Priority options: *

Confirm your details

Terms

Do you agree to the above Terms? *

Coupon Code

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