The ABDO offices will be closed on bank holiday Monday
Authorisation for disclosure of medical information relevant to employment
Name: | Date of birth: | ||
Address: | |||
Telephone no: |
To: | |||
Doctor’s name: | Consultant’s name: | ||
Address: | Address: | ||
Telephone no: | Telephone no: | ||
Hospital reference no: | |||
Signature: | Dated: |
I hereby consent to a medical report being supplied in confidence to my employer.
I understand my rights under the Access to Medical Reports Act 1988 and have read the summary of my principal rights under the Act attached to this form.
I do/do not wish to have access to the medical report before it is supplied. |
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Signature: | Dated: |