Consent for a Doctor's Report Form (UK) (Acas)
The Acas Consent for a Doctor’s Report form allows employees to authorize their employer to request medical information from their doctor in compliance with the Medical Reports Act 1988. It ensures that employees understand their rights, including the option to review the report before it is shared, promoting transparency and informed consent in workplace health assessments.
Consent for a Doctor's Report Form
Name: [name]
Address: [address]
Date of birth: [date of birth]
Doctor name: [doctor name]
Doctor address: [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: [signature date]
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About this template
What is this template?
This is a statutory consent form used to comply with UK health privacy laws during employment. It contains specific check-boxes for report inspection rights and a 21-day deadline for contacting the doctor that a standard general NDA would lack.
When should you use it?
Use this form when an employer needs to understand an employee's medical condition to make reasonable adjustments or assess fitness for work. Use a Subject Access Request (SAR) instead if the employee is requesting their own data from the employer rather than the doctor.
What's inside
| Clause | Name | What it does |
|---|---|---|
| I give consent | Employer Consent | The employee provides explicit permission for an employer to obtain a specific medical report from a named doctor. |
| I want to see a copy | Right of Access | The employee elects whether to view the report before it is shared with the employer, subject to a 21-day contact requirement. |
| Medical Records Act 1988 | Statutory Acknowledgment | The signatory confirms they have read and understood their legal rights under the Access to Medical Reports Act 1988. |
Who it's for
- an employer needing to obtain health information from an employee's GP for occupational health reasons
- a UK employee authorizing their doctor to release a medical report to their workplace
- occupational health professionals managing medical record access under the Access to Medical Reports Act 1988
How long it runs and how it's signed
Law it's drafted under
England & Wales note
This version is drafted for England & Wales. Scotland and Northern Ireland differ on some points — for example notice periods and tribunal procedure. Tell GitLaw where you hire and it adjusts the draft.
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