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The GP Clinic

DOCTORS ARE ONLINE NOW

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: Work Adjustment Assessment
Your Details
Full Name *
Email *
Mobile Number *
Date of birth *
Sex *

Medical Questions

Reason for Adjustment (Choose one) *
Other (Please specify):

Medical History

Have you been diagnosed with any medical conditions that may impact your work? *
If yes, please list:

Are you currently taking any medications? *
Please tell us which medications and their doses that you take.

Current Work Activities

Physical Demands:

For each activity, choose the frequency and intensity that best describes your job:
Sitting *

Standing

Walking

Bending

Reaching above shoulder level

Climbing stairs

Does your work involve lifting (weight):
Does your work involve exposure to extreme temperatures

Mental/Emotional Demands:

For each activity, choose the frequency and intensity that best describes your job:
Working independently

Working under pressure

Meeting deadlines

Multitasking

Concentration

Decision making

Emotional stress

Interaction with others

Work Environment:

Are there any environmental factors impacting your ability to perform your job duties? *
If yes, please describe:

Functional Limitations

How does your medical condition or limitations impact your ability to perform the following work activities? (Choose one for each)
Lifting objects:
Sitting/Standing for extended periods:
Working specific hours (e.g., nights, weekends):
Performing specific tasks (describe)

Performing above specific tasks (Impact)
Meeting deadlines:
Working independently:
Interacting with others:

Recommended Adjustments

Do you have any suggestions for adjustments that could help you perform your job duties more effectively?
If yes, please describe:

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.

£39.00
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:
Work Adjustment Assessment

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? *

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124 City Road, London, EC1V 2NX

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