List of Private Fees

CERTIFICATES 2021/22 FEE
‘To whom it may concern’ note £30.00
Private sick note £30.00
Pro-formas simple/complex £30.00 - £89.50
Private prescription for drugs not needed immediately by patients travelling abroad £30.00
Freedom from infection certificate £30.00
Vaccination certificates - Dependent on vaccine See reception
Holiday cancellation Form – Simple/Complicated £30.00 - £63.00
Fitness to travel certificate/extract from records £30.00
International certificate of vaccination £30.00
BUPA/PPP Certification £45.00
Report of incapacity to work £45.00
Power of Attorney: In Surgery / At Patient’s Home £120.00 / £180.00
 
REPORTS 2021/22 FEE
Insurance claim forms BUPA/PPP/Norwich Union:  

pro forma

£55.00

extract from records

£75.00

Report on prospective subscriber £60.00
Accident full medical & report: £148.00

Report

£98.50

pro forma

£66.00

Sickness insurance Examination & report £170.00
Extract from records

£60.00

Certificate of incapacity

£20.00

Sickness/accident benefit claim form (extract from notes) £72.00
Sickness/accident short certificate without examination £20.00
School fees/insurance claim form £30.00
Employer’s report and opinion without examination £90.00
Employer’s report and opinion with examination £150.00
Copies of reports for patients under Access to Health Records Act 1990 £0.50 per side + £10.00 admin fee
Access to records under Data Protection Act £10.00 admin where excessive request
Access to manual or mixed records Up to £50.00
Attendance Allowances/disability living allowance:  

GP factual report

£63.00

DS 1500 form

No charge

Housing reports:  

Examination & report

£60.00

Report only

£30.00

 
MEDICAL EXAMINATIONS 2021/22 FEE
Fee for medical consultation - private patient per hour

£60 for up to 15 mins

£240 per hour

HGV, LGV, PCV, taxi driver examination with/without full medical

£170.00

Inc. £20.00 non-refundable deposit when booking

Fitness to exercise examination and report: £170.00

Proforma, 63

£30.00 - £63.00

short note

£30.00

Fit to attend state school examination & Report: £170.00

Report

£63.00

Life Insurance proposal - GP Report £133.00
Life Insurance proposal - GP examination and report £170.00
Life Insurance supplementary report £30.00
Nursing/Residential Home Assessment. Report Only £63.00

Examination & Report

£170.00

Child Minder Ofsted Declaration Form £63.00
 
ADOPTION FORMS 2021/22 FEE
Initial Health Assessment (IHA) – Looked after child £81.50
Forms M, B – Obstetric neonatal reports £46.50
Forms C,D,YP or AME – Full medical examination of child £101.10
Form AH – Health Assessment prospective carer £92.00
Form AG2 – update report, parent/carer £30.00
 
DRIVING FORMS (DVLA) 2021/22 FEE
VOC Cert DVLA £30.00
Series 2 pro forma DVLA £44.00
Visual fields copy from records £46.00
VOC Testing ECG DVLA £133.00
Local Authority PCV/LGV driver £133.00
Mental Health Act sectioning (part 2 – not 12/2 approved) £80.00
 
PRIVATE PATIENTS 2021/22 FEE
Consultation with a doctor 10 minutes £63.00
Consultation with nurse £35.00
Home visit £80.00
Telephone consultation with doctor/Email response £30.00
Private prescription without a consultation £30.00
Referral letter to private consultant £30.00
Fees for tests and investigations will vary according to the tests required

Price List for Non-NHS Services April 2021 (Last revised June 2019)

© Tree View Designs Ltd 2021