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Referral Form Launched

11 August 2010

Business Health Ireland are pleased to announce the launch of our new online Referral Form.

The information you provide will be stored in this electronic questionnaire, and may also be stored securely in printed form. The data will be held in accordance with Data Protection Legislation. The medical information you provide in this questionnaire will be treated in the strictest of confidence by Business Health Ireland. Please complete all sections of the questionnaire as thoroughly and accurately as possible.

Certain fields are compulsory, and the questionnaire will only allow you to save and submit it once these questions have been answered. Once you have completed the questionnaire, you can save a copy to your own computer and then click the Submit button on the last page.

This questionnaire has been designed to allow you to complete it online. You will need the free Adobe Acrobat Reader software (version 8 or higher), which you can download here. Alternatively, you can simply print out this questionnaire and post it to Business Health Ireland. If you have any questions regarding this form, please contact Business Health Ireland on +353 (0)21 4355950 or email info@bhi.ie.