Occupational Health Management Referral Form

Staff in Secure and Specialist Learning Disability, Corporate (Mersey Care staff), Local and Community divisions please download and complete this form

When you have completed it please email it to occupationalhealth@merseycare.nhs.uk

Mid Mersey Division (inc previous NWBH corporate) if you haven’t previously, please register at https://5bpcohort.shk.nhs.uk/CohortManRef/newuser.aspx as a new user to enable electronic referral.

Once registered with Cohort this is the link used to complete the referral - https://5bpcohort.shk.nhs.uk/CohortManRef/Login.aspx

If you have any queries contact: 01925 664010

Self referral

Mid Mersey Division (inc previous NWBH corporate) can self refer to Occupational Health by using this form.

If you recently referred a member of staff to the occupational health clinic we would like to find out how helpful our reports are so that we can continue to improve the service that we provide to you.

We would be greatful if you could spend a few minutes completing the questionnaire below. Your answers will be treated in confidence.

Thank you in advance for your help.

For completion by the manager on receipt of OHS report


Taking part in this survey is voluntary. You response will be anonymous and treated in confidence

What is this survey about?

This survey is about your most recent appointment with the occupational health (OH) department. The purpose of this questionnaire is to ask about your opinions and experience of the recent appointment in order to improve and maintain a high quality service.

Completing the questionnaire

Please complete the questionnaire within a day of your appointment.

Questions or help?

If you have any questions, please call the Occupational Health unit

For completion by the client