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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