Complete the appropriate form/s below or download in PDF format, print, and and return to the FirstMed Offices:
Please note that it is necessary to click both blue fields at the end of each form in order for our colleagues to receive them both.
Please do not write in ‘ALL CAPS’, use Proper Case [e.g. Smith, John]
Download as a PDF here or complete online below:
Download as a PDF here or complete online below:
Medical Information Release Consent Form
I hereby acknowledge that FirstMed-FMC Kft. may hand over medical documentation related to me to the person and/or in the manner I have designated in this declaration. The medical documentation shall be deemed as handed over to me – in case of personal delivery, by the delivery, in case of an e-mail, by the sending, and in case of registered mail, by the sending. Therefore, as long as my instructions as stated herein are followed, I may not raise any claims against FirstMed-FMC Kft. regarding the handing over of my medical documentation, and I may not claim that FirstMed-FMC Kft. has breached my privacy rights with regard to the disclosure of my medical documentation.
