Guide to buying a document holder!

Do you have neck and shoulder pain and want to know what would help you work more comfortably and with less pain? Find out with our quick guide....

read more...
Don’t rush into buying a new laptop until you’ve read these facts?

The first thing anyone thinks about when buying a laptop is getting the fastest processor or the biggest hard drive but there's more to think about if you want to avoid future problems.....

more…
Headaches, blurred vision, dry or red eyes?

These are just some of the visual symptoms you can get from using a computer. If you want to know more on how to prevent these problems and others......

more…
website graphic | workfuture.co.uk

Functional Capacity Evaluation

Edit this page to put your info / intro here.

Business Details

Your Name:
Business Name:
Business Address:
Postcode:
Email:

(Please note that confidential referral information will be sent to this address)

Telephone:
Fax

Client Details

Your Reference:
Client Name:
Address:
Postcode:
DOB:
Home Tel:
Mobile:
Evaluation Location:
Nearest clinic to client's address.

Disability and Employment

Impairment(s):
Date First Absent from Work:
Date of Accident / Onset:
Occupation:

Job Description

Sitting  - hrs/day:
Standing hrs/day:
Walking hrs/day:
Carrying:  
Lifting:  
Pushing / Pulling:  

Specific Questions and Instructions

Please provide us with a report following this assessment
Please make available recommendations to facilitate vocational rehabilitation
Please indicate any treatment needs and likely costs within your report
Other (please specify)

Service(s) Required
Full Functional Capacity Evaluation (FCE)
Physiotherapy Treatment
Quotation for Rehabilitation and Case Management:
 
 
FOR A FREE OCCUPATIONAL HEALTH CHECK
Call  0845 450 7316
 
WorkFuture Nottingham - Mercury House, Shipstones Business Centre, New Basford, Nottingham. NG7 7FN.
W3C HTML 4.01 compliance logo   W3C CSS compliance logo