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Occupational Health Form

Occupational Health Form

Referral Form

Section 1

Instruction Type

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To help support the differing requirements of our customer base we offer two assessment and reporting options. The first is a lite assessment which is a telephone assessment where the appointment will take place within 5 working days of the referral and the report returned to you within 72 hours. The second is our comprehensive option which is a face-to-face assessment followed by a detailed report.

Referrer contact details

Section 2

Employee contact number

Section 3

Section 4

Current fit note details (if applicable)

Please can you request that the employee brings any clinical information/ letters, prescriptions or any other information with them to the appointment to assist with the assessment?

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