MANAGERS REFERRAL FORM
NB The PDF may open in your browser. If you want to download it to complete it digitally, please right-click (or control-click) and choose “save link as”.
Our Specialist Physician will contact the staff member and offer an appointment within 10 working days of receipt of the form.
After the appointment the Specialist will prepare a Occupational Health Report addressing the issues you have raised and email it to you within five working days of the assessment.
The completed document with relevant attachments can be emailed to email@example.com, or by post to:
4 Queen Street,
Any questions? Please call us on 01225 471449
All your medical and personal information will be treated with the utmost confidentiality according to General Medical Council guidelines and if there is any need to share it with anyone your consent will be sought first.