CONSENT FORM

(Medical Assessments)

I understand that:

I agree to having WMC report the findings of my medical assessment, relating to my current illness or injury, to my Employer for the purposes of determining my fitness and/or ability to perform my job/occupation.
My employer has requested and paid to have a medical assessment completed by Workplace Medical Corp or its representatives.
Any personal information provided to or collected by WMC will be managed according to the privacy laws, including the Personal Information Protection and Electronic Documents Act, as well as Workplace Medical Corp.’s Privacy Policy.
This consent has been given voluntarily, and I am not, in any way, being treated by Workplace Medical Corp. or its representatives.

I ACKNOWLEDGE & AGREE that(Required)

I have read and understood the above. I have been given an opportunity to ask questions.

Date(Required)

Name(Required)

First Last

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