Abbott Clients MEDICAL RELEASE CONSENTPlease complete the section below to confirm that you agree to the release of this information: I hereby agree to the following* I give permission for The London General Practice to conduct an Occupational Health Assessment requested via Abbott Healthcare Connections Ltd. I also give permission for The London General Practice to release both the Occupational Health Fitness Status Report and Occupational Health Assessment Referral Report in full to: Abbott Healthcare Connections Ltd. Should I wish to review or amend the reports prior to being released to my employer, I reserve the right to do so with Abbott Healthcare Connections Ltd as per my signed consent form. I understand The London General Practice will store my personal and medical information on file, which will be held securely on their database. Name* First Last Employee’s signature Date* DD slash MM slash YYYY CAPTCHA
