Free template
Medical report template
A structured report for a solicitor, insurer or employer who asked for one, with the request and its reference at the top.
Download the PDFFree, no sign-up. Fill it in on screen or print it.
What it asks for
What is on the formThe secretary completes
- Practice letterhead, date and reference
- Patient: name, date of birth, MRN and address
- Requested by, report date and their reference
- Reason for report
- Relevant medical history
- Current medications
- Clinical opinion
- Sign-off: name, qualifications and Irish Medical Council number
Using it well
- Keep a copy of the request and the patient's written consent to release the report.
- Answer the questions the requester asked, in their order.
Open it in the sample practice
The sample practice is the real Ask Brigid on invented patients, open without a sign-up. This document joins its Library with the next sample-practice update; the Library already holds the practice’s templates.
Sources
- The shipped template's field list (Brigid stationery v12), read 24 October 2026
Checked against the sources above on 23 September 2026. Issuers change their forms; check the official page before you rely on a detail here.
In Ask Brigid this paperwork sits beside the diary and the record: Practice management for private consultants.