LGV/PVC Medicals | Private Hire Medicals

Your Full Name *

Date of Birth *

House No. *

Address *

Town/City *

Postcode *

Phone Number *

Email Address *

Are you applying for a grant or renewal? *

Grant – First Application
Renewal – Subsequent Application

Full Name of Your GP *

Write N/A if no GP is assigned to you.

GP Surgery Name *

GP Surgery Address *

GP Surgery Town/City *

GP Surgery Postcode *

GP Surgery Phone Number *

GP Surgery Email Address *

Firearms Officer Name *

Write N/A if no officer is assigned.

Firearms Licensing Police Force *

Firearms Officer Phone Number *

Firearms Officer Email Address *

Have you declared any medical conditions on your firearms/shotgun licence application/renewal form? *

Consent for Midland Medical Group to carry out our full medical reporting process (please read thoroughly) *

I consent

I consent to Midland Medical Group requesting my medical records from my GP and holding and reviewing my full medical records as part of my firearms/shotgun application or renewal. I also consent to any relevant medical conditions being disclosed on my medical report verification and subsequently reported to the police. I consent to my report being sent directly to the firearms licensing officer (in cases where the police accept this) or back to me by email/post in cases where the police require the report to be sent back to me. As per 2019 Home Office statutory guidance I consent to Midland Medical Group writing to my GP surgery to request that my NHS GP adds a marker to my patient record (if such a marker is not already present on my patient record) to enable the NHS GP to flag up to police any new medical issues which emerge following the grant of the certificate.

Consent to report being sent to police by non NHS email *

I consent
I do not consent and accept that my report will only be sent to police by post

For police forces that allow the report to be sent directly to them, please provide consent for us to email your report to the police via a non NHS email. Police guidance states that they cannot be held responsible for any loss or inappropriate access to emails sent to them from a non NHS email address. If you do not give consent we will send the report by recorded post only. For force areas that request that your medical report is sent back to you we will email you or post the report if you prefer.

Print name for signature purposes *

To confirm your consent, write your name.

Private Medicals, including HGV/D4, Taxi and Motorsport Medicals, Only £45

Book your firearms/shotgun medical by filling out our online referral form