STARTING THE PROCESS
(Click BLUE form titles below to view or print)
 
1 - Download, fill out, and e-mail back the following form: 
             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 printed on the form.

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

4 - Due to COVID-19 all clients will now be 'screened' both at the time an appointment is scheduled (over the phone) as well as again at the start of the appointment (in person). Additionally, the client will be required to review and sign the: CLIENT AGREEMENT TO RECEIVE SERVICES DURING COVID-19 PANDEMIC


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.

   
                   http://bcert.me/plbugufr

www.TheSafeDriver.com