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Medical Consent
MEDICAL CONSENT
Date: [Date of Notice]
[First Name of Recipient] [Last Name of Recipient]
[Company Name of Recipient]
[Street Address of Recipient]
[City of Recipient], [State of Recipient]
[Zip Code of Recipient]
[Country of Recipient]
Dear [Mr./Mrs.] [Last Name of Recipient]:
For the limited purpose of consideration of employment with [Name of Employer], I, the undersigned individual, asserting that I am over the age of majority do authorize the following medical examination: [Medical Examination].
I realize that the medical examination will be conducted for the benefit of my prospective employer and will be included as a part of my prospective employer's determination whether to extend an offer of employment to me.
I release both the medical professional who will conduct such tests and from all liability for diagnosis and treatment. I voluntarily authorize this consent without limitation or uncertainty.
[Name of Employee]
Signature