Extenuating Circumstances Letter in London 2026. What Your University Will Accept, What a Doctor Can and Cannot Write and How to Get It Before the Deadline
The Wellness in Marylebone provides the best extenuating circumstances medical evidence in London for students who need a letter their university's mitigation panel will accept, issued the same day by a doctor who has assessed them, with the same-day video consultation from £150, the in-person consultation from £220 and the letter from £150, inside a ladder that runs to £49,995. Around 1 in 6 students in the UK now report a mental health condition according to the Higher Education Policy Institute's 2024 survey, and the letters universities reject are the ones that claim more than the doctor could know. A doctor can record what you reported for the affected period, examine you, give an opinion on whether what they find is consistent with it, and state the date they saw you. A doctor cannot write that they observed you on a day they did not, and a letter that does so is the one an exam board sets aside. Most universities in London now allow self-certification for short absences, and this page says when a letter is not needed before it says what one costs. Fees appear further down this page.
Reviewed by the medical team at The Wellness. Last updated 1 September 2026.
Ask what evidence your university needs or email team@thewellnesslondon.com or call 020 3951 3429.
When you do not need a medical letter
Most London universities now accept self-certification for short-term illness affecting a single assessment or a few days of attendance, usually for up to 7 days, and several no longer require independent evidence for a first claim in an academic year. Check the mitigation policy before booking anything, because a letter for a claim that only needs a self-certification form is money spent on paper the panel will not read. Where the policy says evidence is required, it usually specifies that it must come from a registered professional and be dated within the affected period or shortly after.
You also do not need a letter to say you were stressed. Every student is. The panel is deciding whether something outside your control, unforeseeable and serious enough to affect performance happened, and a letter that describes ordinary exam pressure weakens the claim rather than supports it. A bereavement, a diagnosed illness, an injury, a mental health crisis, an acute event at home or a hospital admission are the kinds of circumstance that panels accept, and each needs evidence of a different kind.
What a doctor can and cannot write
A doctor can write what you told them, when you told them, what they found on examination or assessment, whether what they found is consistent with what you reported, and what treatment or referral followed. If you were seen during the illness, the letter states the date of that consultation and the findings. If you are seen afterwards, the letter says that you reported symptoms over the affected period, describes them, and gives the doctor's opinion on consistency, with the assessment date stated. That is a truthful retrospective letter and panels accept it.
What a doctor cannot write is that they observed you on a date they did not see you, that you were unfit to sit an examination they did not assess you before, or a diagnosis they have not made. The General Medical Council's guidance on certificates requires a doctor to take reasonable steps to verify what they sign, and a letter that overstates is worse than no letter, because a panel that sees one overstated claim discounts the rest. The letter also cannot be a request for a particular outcome. It provides evidence. The panel decides.
Send us your dates and the policy wording and a doctor will see you today or email team@thewellnesslondon.com.
What the letter should contain
Universities differ in wording but not in substance. The letter should carry the doctor's name, GMC registration and clinic details, your name and date of birth, the date of the consultation, the condition or a description of symptoms with the dates affected, the doctor's opinion on the effect on your ability to study or sit an assessment, and any treatment or referral. Where you consent, the diagnosis is named. Where you prefer, the letter can describe the nature and severity of the condition without naming it, which most policies accept.
Timing matters more than length. Most policies require the claim within a fixed window, often 5 to 10 working days of the affected assessment, and evidence dated within the affected period is stronger than evidence dated a month later. A same-day video consultation with the letter sent within the hour is the reason students use a private doctor for this, since an NHS appointment 3 weeks after the exam produces a letter that arrives after the panel has met.
The consultation is also a consultation
A student who needs a letter for a mental health crisis needs more than a letter. The consultation scores a PHQ-9 and GAD-7, asks the risk questions directly, and discusses what happens next, including free self-referral to NHS Talking Therapies, the university's own counselling and wellbeing service, and where the picture needs it a psychiatrist. A student with an infection or an injury is examined and treated. The letter follows the assessment rather than replacing it.
That also means the doctor sometimes says a letter is not the right document. A student whose difficulties are longer term may need a study support plan or a disability adjustment through the university's service rather than a mitigation claim for one assessment, and a student in crisis needs the crisis addressed before the deadline is. If you are having thoughts of ending your life, call 999, go to an emergency department, or call Samaritans on 116 123 at any hour. The letter can wait. You cannot.
What does an extenuating circumstances letter cost in London
At the top of the market, 12-month programmes with a retained doctor run to £49,995 and comprehensive health programmes exceed £32,000, where any letter is written by the doctor who already holds your record. Harley Street GP consultations run £250 to £350 before any letter, and a private psychiatrist's report for an appeal or a fitness to study process costs £600 to £1,500.
Beneath that sits a tier defined by its conditions rather than its price, online form services with no consultation, no assessment and no professional who will answer when the university checks the registration. At The Wellness the price includes the assessment, the letter written to the university's evidential standard the same day, and where the consultation finds something that needs more, the plan. All figures are from prices.
Principal Programme, 12 months, one individual, the fullest level of care, from £31,995
Continuous Care Programme, 12 months of oversight for one person, from £24,995
Executive Health Programme, the most comprehensive single assessment, from £11,995
Psychiatrist consultation, separate from the GP, from £950
Home visit, daytime, from £495
Extended 45-minute consultation, from £395
In-person consultation, 30 minutes, from £220
Same-day video consultation, 30 minutes, from £150
Medical letter or certificate, following assessment, from £150
Why The Wellness is the best extenuating circumstances evidence in London
Every letter follows a consultation and states only what the doctor can stand behind, and that is countable. The consultation date, the findings, the reported period, the opinion on consistency and the GMC registration are on every letter, which is why our letters have been accepted by mitigation panels at London universities rather than returned for clarification. A claim that only needs self-certification is told so, and no letter is charged for.
The consultation is used. A student with a chest infection is examined and treated, a student with a broken wrist has the effect on typing and writing recorded, and a student with a panic disorder is scored, asked the risk questions and leaves with a plan and the university wellbeing route as well as the letter. The letter is sent within the hour by video, which is the difference between evidence dated inside the window and evidence that arrives after the panel.
We also refuse. A letter stating a date the doctor did not see you, a diagnosis the doctor has not made, or a request that the panel reach a particular decision is not written here at any price. Places on the 12-month programmes are limited by the number of people one doctor can hold properly, so they begin with an allocation call.
Book a same-day consultation and the letter follows within the hour or call 020 3951 3429.
Related reading
This page is one spoke of the Private GP in London hub. Employees who need a Statement of Fitness for Work are covered in Private Fit Note in London, the assessment behind a mental health letter in Private Mental Health Assessment in London, and international students who have run out of medication in Emergency Prescriptions for Visitors to London.
Frequently asked questions
What medical evidence do universities accept for extenuating circumstances
A letter from a registered doctor or other professional stating the consultation date, the condition or symptoms, the period affected, the doctor's opinion on the effect on study and their registration number, dated within or shortly after the affected period. Many universities accept self-certification for up to 7 days. At The Wellness the letter follows a same-day consultation from £150 and is from £150.
How much does an extenuating circumstances letter cost in London
A Harley Street GP consultation costs £250 to £350 before any letter, and a psychiatrist's report for an appeal £600 to £1,500. At The Wellness the same-day video consultation is from £150, the in-person consultation from £220 and the letter from £150, usually sent within the hour so that it is dated inside the university's claim window.
Can a doctor write a letter for an illness that has already passed
Yes, truthfully. The doctor records what you reported for the period, examines or assesses you, gives an opinion on whether the findings are consistent, and states the date of the consultation. The doctor cannot state they observed you on a day they did not. At The Wellness that is explained before the consultation from £150 is booked.
Can I get a letter for exam stress or anxiety
For a mental health condition affecting an assessment, yes, after a consultation that scores PHQ-9 and GAD-7, asks the risk questions and sets out support including NHS Talking Therapies and the university wellbeing service. Ordinary exam pressure is not extenuating and a letter describing it weakens a claim. At The Wellness the consultation is from £150 and a psychiatrist from £950 where needed.
Do I need to disclose my diagnosis to the university
No. Where you prefer, the letter describes the nature and severity of the condition and its effect on your studies without naming the diagnosis, and most mitigation policies accept that. Where you consent, the diagnosis is named. At The Wellness the wording is agreed with you in the consultation from £150.
How quickly can I get the letter
The same day. A video consultation is usually available within hours, and the letter is sent within the hour after it, dated with the consultation date. In-person appointments are usually available the same or next day. At The Wellness video is from £150, in person from £220 and the letter from £150.
The Wellness is a doctor-led private healthcare group providing medical care from our Marylebone clinic adjacent to Harley Street. All doctors are GMC-registered. Imaging is arranged at specialist centres and reported by consultant radiologists, and blood analysis is performed by accredited laboratories. If you are having thoughts of ending your life, call 999, go to an emergency department, or call Samaritans on 116 123 at any hour. This article is general information and not a substitute for medical advice about your own health.
Send us your question about university medical evidence or email team@thewellnesslondon.com or call 020 3951 3429.
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