NOTICE:
 THIS IS NOT A BOOKING FORM !

Please fill this form only after you have made a booking on our website.

You must fill this form prior to your appointment.

Your clinician will review this form with you again on the day.

If you require further guidance, please call +44 (0)20 4617 6186 or email us on yehs@yourexcellenthealth.org

For Government Guidance on the Seafarers Medical Certification,

CLICK HERE

MEDICAL EXAMINATION OF SEAFARERS CONSENT

Privacy Notice
Personal information collected as part of your medical will be entered into the Approved Doctors Information System. Your information is shared with the Maritime and Coastguard Agency (MCA), Chief Medical Advisor, any subsequent Approved Doctors you attend, and MCA administrators if required, for them to fulfil their statutory duties under the Merchant Shipping (Maritime Labour Convention) (Medical Certification) Regulations 2010 or the Merchant Shipping (Work in Fishing Convention (Medical Certification) Regulations 2018, which implement the UK’s international obligations under the Maritime Labour Convention, 2006 and the Work in Fishing Convention, 2007.

For more information explaining how your information is used, please view our full privacy statement at www.gov.uk/mca

Consent to examination
Purpose of the examination: It is a legal requirement for a seafarer or fisherman to hold a valid medical certificate attesting to their medical fitness to perform their duties, taking into account the particular risks associated with working at sea. The medical examination is conducted in accordance with statutory medical standards set by the Secretary of State and overseen by the Maritime and Coastguard Agency. Further details, if required, may be found in MSN 1886 (M+F) and the Approved Doctor’s Manual.

Nature of the examination:  The Approved Doctor will review your medical history and then examine you. The average duration of the assessment will be 30-45 minutes.

The standard examination will at a minimum include:
- Observation of posture, movement and gait
- Pulse, blood pressure, height, weight, urine test
- Examination of skin and also leg veins
- Clinical test of ears and hearing if necessary
- Clinical test of eyes and eyesight
- Examination of teeth, gums, mouth and throat
- Examination of heart, lungs and neurological system
- Examination of abdomen including checking for hernias
- Other tests that might be clinically indicated from the history will be explained

It will be necessary for you to be partially undressed to conduct a full examination (down to bra and underpants for females and underpants for males). Privacy and dignity will be of paramount importance at all times and you will be offered a chaperone.

Further information may be required from your GP or specialist prior to making a fitness decision.

End of Form