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Medical questionnaire (doctor)

Thank you for taking the time to complete this questionnaire. Your patient has applied to become a foster carer with Brophy Family and Youth Services, and has nominated you as their doctor.

As part of the assessment process, we're required to understand the physical and psychological health of prospective foster carers to ensure a safe, stable environment for children and young people in care. Your responses will be treated confidentially and used solely for this assessment.

A copy of your patient's signed consent for you to share this information has been provided alongside this form.

Doctor's details

Name of the doctor completing the questionnaire

Phone number

Email address

Your credentials/qualifications and professional organisations

How long have you been the applicant's mental health practitioner?

Applicant details

Applicant name

Date of birth