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Occupational Health Referral Form

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PRE-REQUISITE QUESTIONS

Before you complete the referral

The questions that we ask you on this page helps us to check that your company has obtained permission from us to use this online referral form after accepting our terms of business and signing up to use this service.

After completing this page and entering a valid username and password, we will take the contact details for the employee you would like to refer to us and your details for us to provide the occupational health report.

PLEASE NOTE: Please ensure that you have electronic copies of fit notes, previous correspondents, medical records or job descriptions when you are ready to submit the online referral as this online referral form will time out after 60 minutes which may require you to recomplete the form.

1. Has your company read, signed and accepted our costs and terms of business?

Your company is not currently recognised as one that uses our occupational health services. If you would like to sign up to use our service, please contact us.

2. Are you the line manager or Human Resources contact for the employee that you would like to refer?

Please arrange for the direct line manager or Responsible Human Resources contact to refer the employee

3. Have you informed the employee about the reasons for the referral?

Please speak to the employee about the reasons why you would like to refer them for an independent occupational health opinion and complete the form once the employee is aware

4. Have you gained either verbal or written consent to refer the employee to The Health and Work Consultancy?

We will not be able to unable to arrange an appointment with the employee. Please speak to the employee to gain their consent to the referral for an independent occupational health opinion and complete the form once the employee has consented.

Please enter your user code provided to you.