Skin Check Consent Form

Please enable JavaScript in your browser to complete this form.

Skin Examination

You are about to undergo a Skin Screening. The examination will be thorough yet can only detect approximately 90% of any existing skin cancers. As your skin may be in the early stages of development, and may not be clinically detectable until a later time. The earlier you detect skin cancer, the simpler the treatment.

Participant's Name

First

Last

DOB

Address

Address Line 1

City

State / Province / Region

Postal Code

Company/Organisation Name

Family Doctor

Suburb

Consent

Consent to the examination of my skin, by a highly trained Medical Practitioner. I am aware that only 90% of skin cancers are detectable at this time. I acknowledge that I am responsible for self-exmination, and that any advice or recommendation made on the day of examination will be followed up by myself and my General Practitioner (GP) for further assessment and treatment if required.

Signature

Clear Signature

Date

EMPLOYEES HEALTH

Skin Examination

EMPLOYEES HEALTH

CONTACT US

EXPLORE