Providing excellence through partnership in health 
Telephone : 0118 977 5036 Email: admin@healthscopeuk.com 

Support Forms 

Below you will find downloadable forms, please click on the appropriate form image to download to your computer 
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EMPLOYMENT HEALTH QUESTIONNAIRE 

These are generic forms enabling us to assess what if any adjustments may be required to enable the employee to function within the role.  
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Ill Health - Management Referral Form 

Please specify whether you would prefer a telephone consultation or a face to face assessment. The questions to be answered are not exhaustive and you may add more if required. Please attach a job description and signed consent. 
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Consent to Obtain Medical Report 

Before we can apply for a medical report from your Doctor or Consultant, we need your consent. 
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