I have to delay my start date with one of the big 4 firms due to getting a surgical procedure - are they usually understanding ? Would you need to provide medical records ?

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Posting as :
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As you were not yet employed by the actual company, I would imagine that you don't have to provide any medical records.
In relation to pushing out your start date, that's really a discussion you need to have with the HR department. I know several people that have done this, and it's never been an issue.
Put your mind at ease just give the HR department or your hiring manager a call...

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