Participant Details

Requestor First Name *

Requestor Last Name *

Requestor Email *

Requestor Phone Number *

Participant First Name *

Participant Last Name *

Date of Birth

Participant Mobile Number *

Participant Email *

Participant File Number *

Proposed Role *

Preferred Location (Provide suburb & postcode)

Country

Alternate Location (Provide suburb & postcode)

Country

Available Day - First Preference

Time available from:

Time available to:

Available Day - Second Preference

Time available from -Second Preference:

Time available to - Second Preference

Available Day - Third Preference

Time available from - Third Preference:

Time available to - Third Preference

Medical Required

Police Officer

Notes:

Please upload any additional information including Green Sheet and Medical Information relevant to the application

Browse

Please note:

If you wish to book a medical that differs from the above services, please contact an Injurynet Program Coordinator first on 1300 307 418 or via email ppm@injurynet.com.au
Cancellations, reschedules and non-attendances will incur a fee

Privacy

Injurynet collects and uses personal and health information about your candidates / employees for the purposes of providing medical assessment services for your organisation. In making this medical assessment request, you are confirming that the candidate or employee has agreed to their personal information being disclosed to us. If you would like more information about how we manage, collect, hold, use and disclose personal information, please refer to our Privacy Statement.

Save and Complete Later