Health Monitoring Questionnaire | Pre Employment

Please read the following and sign where indicated.

Statement authorisation - I hereby authorise Emlpoyees Health and the examining doctor to release any information acquired, collated or ascertained as a result of the examination and consultation to my employer, prospective employer or their authorised representative. I also acknowledge that the findings of this examination may be used by my employer, prospective employer or their authorized representative in relation to my employment. I further acknowledge that Employees Health may use information obtained through previous medicals and/or consultations, in the course of this assessment.