Consent to Share Medical Information

I hereby give explicit consent to The Glen Medical Practice to share my medical records with the named persons on this document. I understand this consent to share will only expire when I cancel it in writing.

ALL of my medical information may be shared: this may include information about my sexual health, family planning, pregnancies, mental health, history of drug or alcohol issues.

I also authorise the persons named on the form to act on my behalf and obtain my lab results, schedule my appointments, check my appointments on my behalf, request and collect medications and access to my hospital correspondence.