Online Form Submission

Management Referrals

Management Referral Form

This form enables management to refer an employee for independent advice so as to help resolve a situation where an employee’s health might be affecting their fitness to carry out their job, or their job may be adversely affecting their health in some way.


On receipt of a completed form, we will contact you within 24 hours to provide you with a recommendation on the most appropriate type of clinician, and offer some available appointment date / time options for your consideration.

Pre-Placement Health Questionnaire – Employer Request Form

This form enables employers to electronically request a ‘fitness for work’ outcome on a prospective employee. On submission of the form, we will contact the prospective employee via email (using the email address provided by you within). We will notify them of your expected return deadline date, and request that they submit a completed health questionnaire using a unique questionnaire link.


Once we receive the prospective employees completed form, we will screen and provide you with an outcome report on their fitness for work within 3 working days.

Pre-placement health assessment