Consent to Release Information forms

As a patient under assessment with the NZ Familial GI Cancer Service, your Family History Assessor may ask you (or your relatives) to complete a Consent to Release Information form. 

These consents allow us to confirm any reported cancers and/or relevant medical history in order to clarify your risk,  give appropriate surveillance recommendations and offer advice as to whether any other investigations are appropriate.

We may require a consent to access information regarding yourself, a relative (to be signed by them) or a deceased relative (to be signed by their next-of-kin). All information is treated as strictly confidential. 

 

If you have been asked to fill out a Consent to Release Information form but have either lost your form or require additional forms, please select from the options below:

Consent to Release Information (Living Individual)

Consent to Release Information (Deceased Relative) 

 

Completed consent forms can be returned via post, email or fax.

Please ensure that your reference number is included on your form (this can be found at the top of any correspondence from our Service) as well as a telephone contact number.