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All details on this form must be shared with the employee being referred, to obtain their consent prior to it being submitted.
The Occupational Health clinical assessment may be performed by an Occupational Health Practitioner within the Cognate Health
By completing this form, you are confirming the employee has been informed and consented to the referral process.
Appointment details may be sent to both the referring manager and the employee however it is the responsibility of the referring
manager to ensure the employee is aware of the appointment and confirm attendance.
The information you provide will be handled in the strictest confidence and only seen by relevant members of the Cognate Health
Occupational Health team.
By submitting this form, I confirm that I have discussed the reasons for and content of this referral with the employee and I will facilitate