1. I hereby give permission for Recovery Partners to conduct a functional assessment to determine accurate physical capacity.
2. I understand assessment will be performed in a safe and controlled manner and may exceed the physical restrictions outlined on WorkCover certificates (if applicable).
3. I am aware that I will not be required to perform any activities that I do not feel comfortable performing. Should I refuse to perform a task, the reason for such refusal will be documented in the reporting of results.
4. I am aware that a functional task may be ceased by the assessor at any stage should the performance of the task be deemed unsafe and/or a risk.
5. I am aware that a functional task may be ceased by myself should I feel incapable of performing the task of concerned regarding abilities to perform the task.
6. I am aware that I should advise the assessor immediately should I experience difficulties with any tested functional tasks.
7. I declare I will provide accurate information and will not omit any information.
8. I agree for the information from this assessment to be provided to the referrer of the assessment as well as, if applicable, my treating Doctor and Employer / Employer representative.
9. The scope of this authority to release medical and personal information is limited to the related injury only.
