Doctors Referral Form

Referral to Bendigo Occupational and Environmental Medicine:

/ /
Occupational injury
Occupational illness
Hazardous exposure (physical, chemical, biological)
Possibly unable to return to full pre-injury duties
Suitable (alternative) employment advice
Workplace conflict
Investigation / assessment
Occupational injury management
Return to work plan
Employer liaison
Worksite visit
Drug or alcohol management plan
Visual Verification Image

* Required

Downloadable Doctors Referral Form (PDF 140 KB) download }

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