Referral Documents – downloadable
See our Services Page for each type of service we offer. We can also provide a combination of one or more services.
Referral documents are available below, depending on the Occupational Health Service you require.
New referrers, complex cases, multiple services/Group assessments eg DSE prevention assessment, F2F assessments: Contact us to outline the situation and we will provide a written estimate.
If having used our services previously (re-referral of similar type cases, where you do not require an initial estimate), you can proceed as detailed below.
See our Healthywork Ltd Terms & Conditions September 2026 .
Referrals to Healthywork Ltd:
Referrals which include personal information on the Referral Form and typically include other health and work documents:
Step 1: Ask your employee to sign the Individual Client Consent Form (1) electronically using this link: https://www.healthywork.org.uk/individual-client-consent-form/
(Our Confidentiality document (UK GDPR Information Notice for individual clients), is included on the Consent form).
I will then forward the completed electronically signed Consent Form to you, for your records and so you can complete the Referral form and send us all of the other paperwork.
Or use this downloadable form: Client Consent Form (1) Healthywork Ltd – Sept 2026
This Consent form process applies to all of the following services provided to individual clients, as numbered on the Referral Form:
- Service 2C
- Service 3 – all (Ergonomic Assessment F2F or Video call)
- Service 4 (Functional Capacity Evaluation)
- Service 5 (Cognitive Assessment)
- Service 6 (Mental Health/Neurodiversity Assessment)
- Service 7 (Career Re-direction Assessment)
- Service 9 – all (General Occupational Health/Occupational Therapy Assessment)
Step 2: Complete the Referral Form: Referral Form 2026 – Healthywork Ltd (completed by the Referrer/Employer).
To open the Referral Form use the word: password.
(Change the password if you wish, upon return of the paperwork, otherwise the above password will remain. Send via your own secure system if you wish)
It is advisable to keep the Referral process completely transparent. It is preferable for the Individual Client/employee to be aware of what has been documented about them on the Referral form. E.g. the reason for Referral and the questions posed on the Referral form, which will be included and answered in the report.
Also pose the questions you wish us to answer, (see the list of example questions included in the estimate), which will be inserted into the report. Also pose your own questions specific to the circumstances. It is good if you can share the questions with the individual, as they will be detailed in the report.
Please be mindful when completing referral documents and in all written correspondence, incl emails, that all parties may read the information, including the individual client. This may be when they read the report or they can submit a Data Subject Access Request (DSAR).
Use separate paperwork for each individual referral.
Step 3: Compile other documents to be emailed, eg
Physical Job Demands Questionnaire (for Service 4 – Functional Capacity Evaluation on the Referral form)
Healthywork Physical Job Demands Questionnaire – line manager to complete
Complete this questionnaire to detail the physical aspects of the existing job that the individual conducts currently or is due to conduct, if suitable.
Please complete the Physical Occupational Questionnaire in as much detail as possible. If there are multiple tasks, provide a document with additional detail. This will help to reduce the time required to review the work tasks on site.
Also, send the Job Description or a list of the tasks, so we have details about the job demands/tasks which we are assessing individual’s abilities against.
The assessment will then conclude if there is a ‘job match’ between the individual’s physical abilities and the physical demands of the job.
This ‘job match’ aspect is not required if they do not have a role currently – but will establish their currently abilities for considering a future role.
(Thus the Occupational Questionnaire and Job Description is not required if there is not a work role currently).
Cognitive Job Demands Questionnaire (for Service 5 – Cognitive Assessment on the Referral Form)
Healthywork Cognitive Job Demands Questionnaire – line manager to complete
Complete this questionnaire for a Cognitive Assessment, to detail the cognitive demands of the existing job that the individual conducts currently or is due to conduct, if suitable.
Provide as much detail about the individual tasks performed as possible, as this will help to reduce the time required to review the work task demands.
Also, send the Job Description and/or a list of the tasks, so we have details about the job demands/tasks which we are assessing individual’s abilities against.
This is not required if there is not a role currently.
Step 4: Email the completed Referral form and other documents (above questionnaires etc) and any other relevant work and health documents the referrer holds (individual has consented on our Consent form) that may be helpful. eg performance improvement plans, internal risk assessments, details of reasonable adjustments/adjusted duties already implemented, return to work plan of hours if they have already be detailed/commenced.
Send all documents to Alison Biggs: alison@healthywork.org.uk
Please keep these documents password protected for confidentiality and password protect any other confidential information you send to us.
The paperwork will then be reviewed and you will be contacted by Alison in order to proceed with the Referral.
We can schedule an assessment appointment once all of the paperwork is in place. We can also hold a telephone discussion about the case, as preferred, at the Referral stage, prior to the assessment being conducted if this would be helpful.
We will keep a time sheet of the input provided (hours/minutes and travel package/costs) and invoice accordingly, as per our hourly rates (see the T & Cs).
The assessment will then conclude if there are any cognitive difficulties and suggest reasonable adjustments if it is likely that they can continue to perform all or some of the tasks.