Loading
Get Voch1 Online Medical Questionnaire
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the VOCH1 ONLINE MEDICAL QUESTIONNAIRE online
The VOCH1 online medical questionnaire is designed to collect confidential medical information relevant to your fitness to drive. This guide provides a clear, step-by-step process to help you complete the form accurately and efficiently.
Follow the steps to complete your VOCH1 online medical questionnaire.
- Click 'Get Form' button to obtain the questionnaire and access it in your browser.
- In Part A, provide your personal details, including your title, surname, first names, date of birth, address, and contact information. Use block capital letters and black ink for clarity.
- In Part B, fill in information about your general practitioner (GP) and any consultants you have seen. Include their names, addresses, and telephone numbers. Specify the dates you were last seen by each.
- In Part C, list any other clinics you are currently attending. Provide the name of the clinic, department, reason for attendance, and the dates you were last seen.
- Complete the cardiovascular health section by indicating any heart conditions you have. Answer all questions with a 'Yes' or 'No' and provide dates where required.
- Detail your current medications, including the names, dosages, and reasons for taking them. Also, provide your height and weight.
- Indicate any cardiac investigations or procedures you have undergone or are waiting for, confirming any relevant details.
- If applicable, complete the VPACE and DEFIB1 declarations by confirming your awareness of driving license conditions and whether you have implanted devices.
- Finally, read and consent to the release of medical information by completing the consent section. Provide your signature and date.
- Once completed, save your changes and use the options available to download, print, or share the questionnaire as needed.
Start completing your VOCH1 online medical questionnaire today to ensure your medical information is accurately submitted.
Heart failure with reduced ejection fraction (HFrEF): EF less than or equal to 40% Heart failure with preserved EF (HFpEF): EF is greater than or equal to 50%
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.