Persona Pre-Employment Medical Booking

Your Company Name *
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Your Name
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Required First Name Required Last Name
Your Telephone *
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Your Email *
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Candidate Details
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URGENT/ASAP/First Available

URGENT/ASAP/First Available
Preferred Appointment Date
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dd-MM-yyyy

If no preference, or you would like us to arrange with the candidate, leave blank.
Time
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HH

MM

AM / PM

*If available. We will co-ordinate a time with your candidate if left blank or time not available.
Preferred Clinic
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Terms and Conditions *
N/A

When booking a medical via one of our Affiliated Clinics, Persona Health cannot be held responsible for any delays that may be incurred in supplying your report. While we strive to provide the best and fastest service, we have little/no control over the delivery timeframes of third-party providers.

I accept the above statement.
Candidate's Surname *
N/A
Candidate's First Name *
N/A
Title
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Mobile Phone *
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Date of Birth
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dd-MM-yyyy
Email
N/A
Type of Medical Required *
N/A

General Pre-Employment Medical
Crystalline Silica Medical (includes Spirometry)
Commercial Drivers' Medical (includes Audiometry, Instant Drug and Alcohol).
Asbestos Medical (includes Spirometry)
Rail Category 3
Additional Medical Components Required
N/A

Please tick/untick all that apply.
Comments
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Terms and Conditions *
N/A

I agree to the standard terms and conditions of business as set out by Persona Health, and that I am authorised to make this booking on behalf of ___.
I understand if my candidate does not show for their appointment, we will be charged a cancellation fee of 50% of the amount due had they completed their medical.

I accept the Terms and Conditions.
Signature *
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E-Signature Field
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Pre-Employment Medical Booking

Candidate Details

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