Letter to an employee's doctor | Acas

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

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

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]

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

Dear [doctor's name]

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

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

I have attached the employee's permission for me to make this request. They [do/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 employee].

I would like information about:

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

Their role involves:

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

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 employee is disabled
reasonable adjustments that might be needed
a likely date the employee will return to work
if a phased return to work, change of duties or other support might help the employee]

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

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

Yours sincerely,

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

*delete as necessary

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

Last reviewed

15 November 2024