Request for non NHS service Non NHS Services Request The National Health Service provides most healthcare to the majority of people free of charge, but there are exceptions. GPs are self-employed and are contracted to provide NHS general medical services for their patients.Sometimes, and increasingly, GPs are asked to provide additional services which fall outside their contract and in these circumstances, they are entitled to make a reasonable charge for providing them. More information on Non-NHS Services can be found on our website, www.springwellmedical.org.uk.Our GPs are unable to deal with any Non-NHS Service requests during regular consultations. To proceed with your request please complete the section below. Once you have completed the form, the GP will review your request, decide if this is something they can complete, decide on the reasonable fee and will pass this to our Clinical Administrators to contact you to discuss this further. Our Clinical Administrators will advise on the fee and organise any further actions (e.g. making an appointment with the GP, provide other supporting documentation), timescales and will collect the fee prior to any work being carried out. All Non-NHS/Private work is additional to our normal busy NHS workload so please be patient while we work on this for you.We are not always able to complete non-NHS reports or examinations, and we may need to direct you to the private sector. Often GP letters are not essential so please double check. This will save us time and you money.Please note all private service fees must be paid in advance. The practice does not accept cash, but we have a card payment machine or we can accept bank transfer. Our Clinical Administrators will guide you through how to pay.Name Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last Date of Birth DD slash MM slash YYYY Address Street Address Address Line 2 City Postcode Telephone Number:SignatureDate DD slash MM slash YYYY Please provide a full description of what is required (please also attach any forms that need completing)Admin Use Only:Date Received and Passed to Clinical Administrator: OptionalFee: OptionalDate Patient Contacted: OptionalAny further details? (CA’s to complete) OptionalDate Fee Paid: (Card payment receipt to be attached): OptionalDate Passed to GP For Completion: OptionalDate CA’s Contacted to Inform Ready For Collection: OptionalDate Patient Collected: OptionalInitials: Optional
