Consent for sharing medical information

Sharing Medical Information (14)

Newsletter

First Name

Last Name

Your date of birth

Your email address

I hereby give access to the person(s) named below to all my medical records.

I consent to the person named below discussing my medical situation with Dr Cindy de Villiers

Name of person who I give consent to, to access my medical records.

Date of birth of person who I give consent to, to access my medical records.

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