WorkWell Professional Referral

Welcome to the WorkWell Service

The aim of WorkWell is to support people with a disability or a health condition to start, stay or succeed in work. Work and Health Coaches can support with a range of support including access to local community based support, personalised support plans, support with employers, support to Access to Work funding and much more.

To be eligible participants must meet the below criteria:

Employed and either absent through sickness or facing health related barriers at work

OR

Recently out-of-work and need health-related support to return to work

Participants must also meet the following criteria:

Participants home address OR address of their GP OR local Jobcentre Plus is in Stockport. We will check that this address is within Stockport.
Participant is over 16.
Participant has the right to work in the UK.

"*" indicates required fields

Referrer Details

Name of Referrer (NOT the patient)*

First Last

Referring Organisation*

Referer email*

Referrer Phone*

Participant Details

Name*

First Last

Date of Birth

GP Practice

NHS Number (if known)

National Insurance Number (if known)

Home Address

Address Line 1 Address Line 2

Home Postcode*

Postcode

Phone Number*

Email

Referral Details

Reason for Referral:*

In work and struggling due to a health related barrier

In work and off sick due to health related barriers

Struggling to find work due to health related barriers

Not looking for work due to health related barriers

Other

Do they have the right to work in the UK?

Yes

No

How did you hear about us?

Is there any additional information you'd like us to know at this point?

I confirm I have made the person I am referring aware and they give consent to the Work and Health Coaches having access to their medical records. I have also made them aware and they agree to their WorkWell records being shared with their GP Practice.

Yes

No

Name

This field is for validation purposes and should be left unchanged.