Personal Independence Payment (PIP) Request

Personal Independence Payment, also known as PIP, is extra money to help you with everyday life if you have an illness, disability or mental health condition.

You can get it on top of Employment and Support Allowance or other benefits. Your income, savings and whether you are working do not affect your eligibility.

Read Citizens Advice information about PIP

Requesting supporting evidence

To request supporting evidence from your GP surgery, please complete the form below.

The surgery will review your request and contact you if any further information is needed.

Your details

Full Name

Date of Birth

For example, 15 3 1984

Day

Month

Year

Address to include Post Code

Telephone Number

Email Address

About your application

What data are you requesting?

Please provide as much detail as possible as to the data you are requesting, include time periods and specific episodes of illness or treatment wherever possible.

Identification

In order, to protect your information, we are unable to respond to a request unless we have confirmed your identity. Please provide one form of identification and one proof of address.

Documents that can be used as proof of current address (must be dated in the last six months)

Please upload the relevant document as proof of address

Please upload the relevant document as proof of identity

Cwmfelin Medical Centre