Medical report consent form template
Value bundles that include this:
To be completed by the subject of the request and returned to the employer.
Additional implementation support:
Why this form is necessary
This Medical report consent form template aims to offer you a versatile and customisable tool, serving as a solid foundation for your needs. Utilise it to ensure consistency, enhance accuracy, and save valuable time.
Adapt it to suit your unique requirements, ensuring efficiency and effectiveness in your HR processes.
Specifications
5 mins
241 words, 1 page A4
1 July 2024
Medical report consent
A copy of this consent form will be enclosed to the GP along with a letter requesting a report.
CONFIDENTIAL
| GP Name: | |
| Address: |
I consent to my employer, [Company], being given a full medical report by the above GP on the present state of my health. I have been informed of my rights under the Access to Medical Reports Act 1988.
Please tick the appropriate box:
[ ] I wish to see the report before it is sent to my employer.
[ ] I do not wish to see the report before it is sent to my employer.
[ ] I will contact the above GP in order to arrange for my access to the report. I reserve my right to request an amendment, to add my own statement or to withdraw my consent for the report to be sent to my employer at that time.
[ ] I require a copy of the report at the same time or immediately after it is sent to my employer.
[ ] I do not require a copy of the report at the same time or immediately after it is sent to my employer.
| Signed (employee): | |
| Date: | |
| Signed (line manager): | |
| Date: |
Version: [1.0]
Issue date: [date]
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