Unity Health

Wenlock Terrace Surgery | Hull Road Surgery | York Campus

Student Disclaimer

Please fill in this form and return it to your surgery.

Unity_Health_University_Disclaimer_Form_Updated_1

CONSENT FOR RELEASE OF MEDICAL DETAILS

Please allow a minimum of seven working days for this request to be processed and for the letter to reach your department. Letters may be done sooner in exceptional circumstances only.

COMPLETING THIS FORM MEANS A LETTER WILL BE SENT TO YOUR DEPARTMENT. IT IS YOUR RESPONSIBILITY TO CHECK THAT THIS INFORMATION MEETS THE REQUIREMENTS OF YOUR DEPARTMENT