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View full libraryThis Medical Report Consent Form records an employee's permission for their employer to request a medical report from their doctor. It also records whether the employee wishes to see the report before it is provided to the employer and confirms that they have been informed of their rights.
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Purpose of this form
This form records your permission for [Company Name] to request a medical report from your doctor in connection with your employment.
Before completing this form, you should have been told why the report is being requested, what information the Company is seeking and who will have access to the report.
The Company will not request your full medical records. The request should be limited to information that is relevant and necessary for the employment matter being considered.
Employee details
| Employee name: | |
| Job title: | |
| Department: | |
| Date of birth: | |
| Employee contact details: |
Doctor details
| Doctor's name: | |
| Medical practice: | |
| Practice address: | |
| Practice telephone |
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This form provides a structured record of an employee's consent when an employer needs to request a medical report from their doctor. It is designed to be used alongside an appropriate request to the employee and the subsequent letter to the medical practitioner.
The form records that the employee has been told why the report is being requested and has been given an opportunity to decide whether to give permission. The employee can record that they do not consent, as well as providing consent where appropriate.
An employee who gives consent can choose whether they want to see the report before it is provided to the employer. The form records this choice clearly so that the employer can tell the doctor when making the request.
The form encourages the employer to identify the purpose of the report and the information that is actually required. A medical report request should be focused on information relevant to the employment issue rather than seeking unrestricted access to medical records.
A completed and signed form provides evidence that the employee was informed about the request and their relevant rights. It can be retained with the associated medical report request and related correspondence.
Information about an employee's health is special category personal data and should be handled securely, confidentially and only by people who genuinely need access to it.
Related HR resources and workflow
Explore the HR resources that may be relevant before and / or after using the Medical report consent form, helping you understand the wider process, maintain appropriate documentation and follow a consistent approach.
This Medical Report Consent Request to Employee Letter asks an employee for permission for the employer to approach their doctor for a medical report.
This Medical Report Request to GP Letter provides a structured way for an employer to request relevant medical information from an employee's GP or other medical practitioner responsible for their clinical care.
Use these best practice actions, recommended timescales and process stages to understand when and how the Medical report consent form should be used, helping ensure each step is handled consistently and appropriately documented.
Understand the common mistakes to avoid when using this HR template, helping you reduce risk, prevent unnecessary costs and ensure the process is handled correctly.
No. An employee can refuse permission for their employer to request a medical report. The employer should then consider what other relevant information is available and whether further action is appropriate.
Yes. An employee who gives consent can state that they want to see the report before it is sent to the employer. The employer must tell the doctor about this when making the application.
No. A request should be focused on the information genuinely required for the employment purpose. A medical report should not be used as a way of obtaining unrestricted access to an employee's medical history.
The employer should not contact the doctor for the report without the required permission. Depending on the circumstances, the employer may consider information already provided by the employee, fit notes or an occupational health assessment.
The completed form contains sensitive health-related information and should be stored securely with access restricted to people who genuinely need it. The organisation should also follow its employee privacy notice and health-information retention arrangements.
HRDocBox provides structured, UK-focused HR templates designed around practical employment processes and current Acas, employment law and data protection considerations. AI can help explain or adapt wording, but a ready-to-use template gives you a consistent starting point and helps ensure important procedural points are not overlooked.
How this content is developed and reviewed
The Medical report consent form template is developed using a practical HR methodology that considers current UK employment legislation, ACAS guidance, CIPD good practice and the real-world HR process it supports. Templates and supporting information are regularly reviewed and updated, with additional reviews triggered by significant changes to legislation, guidance or established HR practice, helping ensure each document remains practical, relevant and suitable for UK employers.
Darryl Horn, Chartered HR Director
Darryl is a Chartered HR professional with over 25 years' experience in senior HR and employee relations roles.
He has extensive practical experience of managing sick management HR processes and founded hrdocbox to provide businesses with practical, professionally developed HR resources grounded in UK employment law and best practice.
HRDocBox has been creating practical UK HR documents since 2009.
"Darryl provides support and advice with excellent judgement, and has a strong understanding of people, policies and UK employment legislation."
"He is someone I trust; consistent, dependable, and committed to doing things properly."
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