12 High Street, Fochabers, IV32 7EP

Telephone: 01343 820247

Fax: 01343 829930


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Non NHS Medical Declaration

To be completed by anyone requiring a medical examination or the completion of a medical pro forma, in support of their non-NHS request, from a 3rd party agency e.g. HGV/PSV, Insurance application, application to take part in arduous activities within or outwith the UK.

Pre-Medical Examination declaration

This is to be completed by the patient and is to accompany their application for non-NHS services. This information will be treated in the strictest confidence and is to provide the GP with enough base evidence for a decision to be made in support of your request:
  • Details of the person making the medical declaration
  • Date Format: DD dash MM dash YYYY
  • Brief heading as to why you are applying for a specific medical examination
  • e.g. son or daughter, or a family member who is unable to complete the form themselves.
  • Please provide the GP with as much information as possible
  • Declaration Questionnaire (21 Questions)

    To be completed by all applicants
  • Please consider giving the GP any additional information that will help process your request.
  • To be signed by the requesting patient
  • This field is for validation purposes and should be left unchanged.