Get Old Mutual Medical Examination Request Form

Filling out the Old Mutual Medical Examination Request Form online is a straightforward process that ensures you provide the necessary information for your medical examination. This guide will walk you through each step to ensure that your form is completed accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the Old Mutual Medical Examination Request Form and open it for editing.
2. Begin by entering the full name of the applicant in the designated field. Make sure to print in block letters.
3. Input the date of birth formatted as day, month, and year (DD/MM/YYYY) in the respective fields.
4. Reference the Scheme Code and enter it accurately in the corresponding section.
5. Carefully read the instructions for the medical examinations and select the appropriate tests required — ensuring you indicate each one clearly.
6. If an HIV test is necessary, ensure that the Life to be Covered reads and understands the Informed Consent Document. This is vital for compliance.
7. Have the Life to be Covered complete and sign Section A of the Informed Consent Document, affirming their understanding and consent.
8. Complete Sections B and C of the Informed Consent Document, ensuring proper identification of the person drawing the sample along with their signature.
9. Confirm all provided information is accurate before finalizing the form.
10. Once completed, save changes to the form. You can then download, print, or share the form as needed.

Complete your Old Mutual Medical Examination Request Form online now to ensure timely processing.