Medical Examination Consent

[Your Company Name]

Full Name:	[Your Name]
Date of Birth:	[MM/DD/YYYY]
Position:
Date:	[Date]
Consent Approval:
I, [Your Name], hereby give consent for the company [Your Company Name] to carry out a medical examination as part of the employment process or ongoing employee health surveillance. I confirm that I have read and understood the consent.
Signature:

Confidentiality:

I understand that the results of this examination will be kept confidential and will only be disclosed to authorized personnel who require this information for employment-related decisions.

Consent to Release Information:

I authorize the medical professional and [Company Name] to share necessary medical information with each other regarding the results of the examination for employment-related purposes.

Right to Refuse:

I acknowledge that participation in this examination is voluntary, and I have the right to refuse to undergo any part of the examination. However, I understand that such refusal may affect my employment status with [Company Name].

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