Consent for a Doctor's Report Form by Acas
This document is a consent form allowing an employer to obtain a medical report from an individual's doctor. It includes options for the individual to consent to the report, request to see a copy before it's sent to the employer, and confirm understanding of their rights under the Medical Records Act 1988.
Consent for a Doctor's Report Form
Name:
Address:
Date of birth:
Doctor name:
Doctor address:
I give consent for my employer to get a medical report from my doctor.
[ ] Yes
[ ] No
I want to see a copy of the report before it is sent to my employer.
[ ] Yes
[ ] No
I confirm that if I do want to see a copy of the report, I will contact the doctor within 21 days of my employer requesting it.
I confirm I have read and understood my rights under the Medical Records Act 1988.
[ ] Yes
[ ] No
Signed:
Date:
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