workplace skin cancer check
- registration form

If you have received an invitation on behalf of your employer for a standard skin cancer check - please complete and submit the following form.

We will advise your employer that you have registered. You will receive a reminder from us before the scheduled Workplace Skin Cancer Check date.

Name

First Name

Last Name

Date of Birth

Mobile Phone Number

Company

Family Skin Cancer History

Please note any previous family skin cancer history. If not know - write 'not know'.

Area or Spot of Concern

Please note any specific spot/s that you are concerned about.

Your GP Details