Freedom of Information Application form

Title

First Name

Surname (Family Name)

Organisation (if relevant)

Home Phone Number

Work Phone Number

Postal Address

Postal Code

Fax

I request access to record(s) covering matters which are

Category of Information Requesting

Medical Facilities

Medical Care

Medical Training

Public Health

Forensic Medicine

Medical Liaison

Secretariat Support

The record(s) I request are

Do you want your request to be expedited (answered in 10 days)?

If you are requesting they be expedited, please note on explanation

I wish to receive a copy/ copies of the record(s) in the following format

Other Format

Number of copies required

I want physical copies of the record(s) to be

I want to inspect/view/listen to the record(s)

I want to have the record(s) emailed to me

Verification Code