(Click BLUE form titles below to view or print)
1 - Download, fill out, and e-mail back the following form: - Driver Evaluation Request (Word) or (Mac/Pages Version) -
             If you prefer to fill it out by hand then you can download the 'PDF' document here and mail it back
2 - Contact your physician and request a referral/prescription for a 'Drivers Evaluation'.  To simplify the process you can also print out our pre-printed 'Physician Referral' form and provide it to the doctor for their convenience. The return fax number is on the form.

3 - Review and return the following form:
(This can be done via e-mail, fax or/and provided at the time of service)

Once the Physician Referral & Driver Evaluation Request are received you will be contacted
to arrange an appointment date & time.

Please Note: Cancellation of appointment with less than 48 hours notice will be charged a $100 cancellation fee.