HSE – Appointed Doctor for Lead

We are now open again for medicals and lead tests.

If you would like to make an appointment or have any questions, please  contact us at dee@brydenmedical.com.
Thank you.
Dr. Helen S Bryden
Occupational Physician.
Questionnaire for Periodic Medical.

Name__________________________________     Date of Birth______________


Contact details Phone ______________________Email ____________________

Job Title____________________________________________________________

Employer’s name:____________________________________________________

How long have you worked with lead?    _________________________________

What was your last blood lead measurement?      _________________________

Do you have or have you had previously:

Symptoms of anaemia or tiredness?                                                                                 Yes      No

Nerve damage or neurological problems?                                                                       Yes      No

Kidney problems or high blood pressure?                                                                        Yes      No

Cancer                                                                                                                                       Yes      No

Infertility?                                                                                                                                Yes      No

Headaches?                                                                                                                              Yes      No

Irritability or mental health issues?                                                                                    Yes      No

Constipation, nausea, stomach pains or loss of weight?                                                Yes      No

Any other health issues?                                                                                                       Yes      No

Do you smoke?                                                                                                                        Yes      No

Further information about your health?






Also an unborn child is at particular risk from exposure to lead, especially in the early weeks before a pregnancy becomes known.

To the best of my knowledge, the information which I have given is correct and I give my consent to this medical assessment, which is for the purpose of health surveillance under the Control of Lead at Work Regulations. I authorize the release of medical information from this assessment to my G.P. if necessary.  I understand that confidential information about health and medical history will be confidentially treated, processed and stored in a secure environment by Bryden Medical Limited and will only be accessed and processed by those staff that have explicit and reasonable need to do so, with due consideration for Data Protection (GDPR 2018).


Signed: ____________________________


Print Name: _____________________________ Date: __________________        

Please email completed forms and any questions to Dr Helen Bryden at helen@brydenmedical.com         Thank you.