Telehealth / Workstation Consultation  

Authority Form to Release/Obtain Information 

Thank you for your interest in our services at Pinnacle Workplace Consultants. Completing the form below will help our Physiotherapists/Occupational Therapists provide you and your workplace supervisor/manager with relevant support and guidance, to assist you in managing your symptoms and/or injury. 

I authorise Pinnacle Workplace Consultants Pty Ltd to release/obtain information relating to my assessment (including any photographs taken) to/from my employer, supervisor effective for 2 years from the date provided below. I accept that this information is relevant to my well-being at work/home and ensure that appropriate strategies are implemented to manage my symptoms and/or minimise my risk of injury. 

Support/questions 

If you have any questions or require additional support please don’t hesitate to contact us on 08 8271 6544 or wehrc@pinnaclewc.com.au

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