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.

 

Useful Website Links

For further information on Familial GI Cancer Syndromes, we have compiled a list of websites that you may find useful: 

InSiGHT

International Society for Gastrointestinal Hereditary Tumours

Resources for HNPCC/ Lynch Syndrome, Peutz Jeghers Syndrome (PJS) and Familial Adenomatous Polyposis (FAP)

MD Anderson Clinic 

MD Anderson Clinic, Texas USA
Resources for HNPCC/ Lynch Syndrome and Familial Adenomatous Polyposis (FAP)

Cleveland Clinic

Cleveland Clinic, Ohio USA

Information of Hereditary Colon Cancer syndomes

St Marks Hospital - Polyposis Registry 

St Mark's Hospital, London UK
Resources for Peutz Jeghers Syndrome (PJS), Juvenile Polyposis Syndrome (SPS) and MYH Associated Polyposis (MAP)