The solicitor’s email is polite and late. It asks for a letter confirming that this person is unwell, and it needs it by Friday. Someone in the family has already decided that any headed paper will do, because the Home Office “just needs to know.” The Home Office already knows people are unwell. That is not the document they have asked for.
An immigration medical letter fails, most often, because it stops at that sentence. What is needed is a structured opinion after an assessment: the conditions, the function, the treatment, the likely course, and a direct answer to the question actually posed. A stamp on the way out of clinic is not that opinion.
The real question is whether anyone has read the request, seen the person, and written to the point.
Chest pain, signs of a stroke, severe breathlessness, heavy bleeding, a severe allergic reaction or symptoms of sepsis need 999 or A&E immediately.
What an immigration medical letter has to do
The short version is this. Bring the exact request from the solicitor or the form, not a vague ask. I examine you. I read the papers. I write to the question. I do not invent a certificate the paperwork did not ask for, and I do not write a conclusion the examination cannot carry.
Here is the longer version, because immigration work is several different letters that get bundled, in a panic, under one heading.
What I look at in clinic depends on what has actually been asked. Sometimes it is whether a person can attend an interview, give an account, or sit through a hearing. Sometimes it is how a condition would be affected by removal, or by the interruption of treatment. Sometimes it is scarring, or a history of harm, which is a different examination and a slower write up. Sometimes it is a language and life in the UK waiver, which is its own test, not a general note that English is difficult. A fit to fly letter is a different document again, and mixing it into an immigration bundle is how both jobs get done badly.
I start with the instruction. Who is asking, for which application or appeal, and what question they want answered. If that is not in writing, we stop and get it in writing. Vague requests make weak letters. “Please confirm they are sick” is not a question I can answer in a way that helps anyone. “Please give a diagnosis, current treatment, functional effect, and an opinion on X” is a question. Even then, X has to be something a GP can speak to. I am not a country expert. I am not an immigration judge. I can describe health and function. I can say what would, in ordinary clinical practice, be required to manage a condition. I cannot decide the claim.
Then I take a history that would stand up if someone later asked how I knew. Onset, course, treatment, who else is involved, what happens on a bad day, what happens if treatment stops. I examine what the question requires. Mental state if the question is about interviews, memory, or risk. The relevant body systems if the question is physical. I read clinic letters, hospital letters, and any previous reports you have, rather than glancing at the top page. The pattern matters more than the single reading. A calm 30 minutes in Palmers Green does not wipe a year of disrupted sleep, missed medicines, or a person who cannot leave the house without a relative.
The piece most people miss is independence. The letter is more use if it reads as an examination, not as a paragraph the representative could have written themselves. Overstatement is obvious. Understatement is also a problem, because Home Office readers are not going to infer the bit you were too modest to say. Plain, specific, sourced. That is the register.
What I will not write
I will not write that someone should be granted leave. That is not a medical opinion. I will not write that they will die if they travel, unless that is actually the clinical picture, which it almost never is in the letters people hope for. I will not copy a draft. I will not backdate. I will not see a relative and write about a person who is not in the room.
It is worth saying plainly: if the examination does not support the request, I will tell you in the room. You can still have a letter that sets out the true picture. You should not pay for a letter that pretends.
When this comes up in consultation, people are often ashamed of needing the document at all. They do not need a lecture. They need the question answered, or an honest refusal to answer it in the form asked.
When to come in sooner
Come in sooner if there is a hearing date, a reporting date, or a deadline in the solicitor’s email. Bring that date on the first call. We will say what is realistic. Reports are usually ready within a few working days once the assessment is done and the papers are to hand. We do not invent a turnaround to win the enquiry.
Come in sooner if the only letter you have is from a clinic that never asked about function. That is the usual hole, and it is the same hole I see in benefits work: a diagnosis without a day.
Do not wait on headed paper if you are acutely unwell.
- Chest pain, stroke signs, severe breathlessness, heavy bleeding, anaphylaxis, or sepsis: 999.
- You are not safe, or you have a plan to harm yourself: 999 or A&E.
- A head injury with confusion, a first seizure, or collapse: A&E.
- A fever in a child who is floppy, or a rash that does not fade: 999.
- Severe abdominal pain you cannot find a position for: A&E.
- A pregnant person with bleeding, severe headache, or reduced movements: maternity triage or 999, not a letter slot.
How we approach this at Clinique Alpa
Call 020 8882 8088, or send a WhatsApp enquiry to 447742163571 without putting case papers in the chat. Say what the letter is for, and the date. We confirm the fee in writing before any work begins. An immigration medical letter is listed from £350 on the appointments and fees page. A language and life waiver letter is listed at £500. A 30 minute clinic appointment is £100 if you first need GP advice. Home visits £250 day, £450 night, if attending 466 Green Lanes is the thing the health problem makes difficult.
You attend. I assess. I write. The letter is sent securely, usually by email to you or, with your consent, to the solicitor who instructed. Clinique Alpa is CQC registered. With your consent I can send a summary to your NHS GP so the record stays joined up. I do not send anything to the Home Office unless that is what you have asked me to do, in writing.
The wider process is on the medical reports page. If you need to be seen here rather than at home, book now once the fee is agreed, or call and we will put the assessment in the diary.
Bring the exact request. Then come in. The letter follows the assessment, not the other way round.
A structured opinion, written to the question, after you have been seen. Read our fees page, or call 020 8882 8088. Immigration letters from £350, confirmed in writing. Clinic 30 minutes £100. In an emergency call 999. Subject to availability.
Written by Dr Mitesh Parmar, MBBS MRCGP, GP and founder of Clinique Alpa, 466 Green Lanes, Palmers Green, London N13 5PA. This article is general information, not personal medical advice. In an emergency call 999. For NHS advice call 111 or visit nhs.uk.