Authorization For Medical Test

I, THE UNDERSIGNED, declare that I am a competent adult at least 18 years old. I hereby grant permission for the following medical test to be performed on me:

I further acknowledge that such tests may involve the temporary invasion or penetration of my body by medical instruments, light, sound, x-rays, or other maging and diagnostic media, and may further involve the obtainment of bodily fluids, tissue, products or waste, all oi which I give up any claim to.

I further certify that all such contemplated tests have been explained to me and that I have provided complete and honest responses to all questions posed to me regarding my health, including pregnancy, disabilities, allergies, and susceptibilities, if any.

I understand that these medical tests are not being performed for my benefit, but are instead performed for the benefit of______________________, which I hereby release from any and all responsibility for treatment. advice, referral, or diagnosis.

I grant this authorisation in exchange for the opportunity to be considered for employment, or for advancement in employment, or because such testing is required by law, and I acknowledge such testing is necessary and relevant to my employment.

I voluntarily make this grant without reservation.

Signed and dated this ____________ day of ___________ 20 __.

_________________________

Applicant

Witnessed by: _________________________

Full Name

Contract law requirements

Bankruptcy  Bill of Sale  Construction  Debt  Wills Rent  POA  Trademarks  Notes  How To Prepare Forms

AboutClausesContact UsDisclaimerLink to UsPrivacy PolicyTerms of Use

Twitter Share with Twitter Facebook Share with Facebook Google+ Share with Google+ LinkedIn Share with LinkedIn


© Business Associates Inc