Letter to a worker's doctor

Template for an employer to get information about a worker's health when it's relevant to their job. Free to use.

You must get permission from the worker before contacting their doctor.

Find out more about getting a doctor's report about a worker's health

You can copy and paste the template text into an email or document.

Template

To: [doctor's name] 
[Doctor's address]  

From: [your name]
[Name of your organisation]
[Address of your organisation]

[Today's date]

Dear [doctor's name]

I am writing for information about your patient [name of worker], who lives at [address of worker].

I am [a / an] [your role] at [name of your organisation]. Your patient works as [a / an] [worker's job title] at the organisation.

I have attached the worker's permission for me to make this request. They [want / do not want] to see the report before you send it to me.

I would like information in order to [manage sick pay / plan work / support the worker].

I would like information about:

[List the things you're asking about. For example:

  • their absence from work, including absence dates
  • their health condition, such as a broken wrist]

Their role involves:

[List any worker tasks or responsibilities the condition might affect. For example:

  • standing for long periods
  • heavy lifting
  • working evenings
  • using a keyboard
  • driving]

I would like to know:

[List any other information you need. For example:

  • the condition's impact on carrying out their tasks or responsibilities
  • whether the worker is disabled
  • reasonable adjustments that might be needed
  • a likely date the worker will return to work
  • if a phased return to work, change of duties or other support might help the worker]

Let me know if I need to pay a fee for this information.

If you're unable to provide the requested information quickly, please reply to confirm you've received this.

Please reply [by email / by post − a stamped addressed envelope is enclosed].

Yours sincerely,

[Your name]
[Your telephone number]
[Your email address]

Download this template

If you need the template in a different format, email digital@acas.org.uk

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