Workers Compensation – Corporeal Health

Mon - Fri 8.30 - 5.00 Sat - Sun CLOSED
(08) 9622 5940

Home
About Us
Our Services
- Workplace Rehabilitation Services
- Exercise Rehabilitation Services
Referral Form
Contact Us

Home
About Us
Our Services
- Workplace Rehabilitation Services
- Exercise Rehabilitation Services
Referral Form
Contact Us

08 9622 5940

Mon - Fri 8.30 - 5.00
Sat - Sun CLOSED

Perth - Northam - Geraldton
Bunbury - Albany - Kalgoorlie

Workplace Rehabilitation Referral

1. Worker’s Information
*
First Last
Date of Birth*
DD slash MM slash YYYY
Telephone number
Claim Number
Insurer
Date of injury
DD slash MM slash YYYY
Injury type
Worker’s address
2. Referring source
- Treating medical practitioner
- Employer
- Insurer on behalf of employer (authority attached)
3. Referral Type
(Medical practitioners and employers must always consult with each other and the worker prior to the referral for rehabilitation assessment)
- Workplace rehabilitation assessment
(Medical practitioners and employers must always consult with each other and the worker prior to the referral for rehabilitation assessment)
If for a Specific Service only (please indicate)
- Functional capacity assessment
- Job demands assessment
- Ergonomic assessment
- Workplace assessment
- Other
Other
- I have discussed this referral with the worker and their
- Employer or
- Treating medical practitioner and they are in agreement.
Referrer’s name
Date
MM slash DD slash YYYY
4. Employer's Details
Company name
Contact name
Telephone
Address
Treating Medical Practitioner Details
Practitioners name
Practice name
Telephone
Address
File
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Corporeal Health’s vision is one of thriving, healthy and sustainable communities, where they have access to first class, innovative occupational and community health services that partner with them to enrich their lives, their communities and local industry.

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Home
About
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Contact

Our Services

Workplace Rehabilitation Services
Exercise Rehabilitation Services

Contact Us

34 Welshpool Rd
Welshpool WA 6106

+61 (08) 9622 5940

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