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STARTING THE PROCESS
STARTING THE PROCESS
(Click the UNDERLINED LINKS below to view or print forms)
1 - Please choose one of the following ways of filling out our Request for Services Form: (Pick one option)
Click this Link for the online form (Recommended)
Download, fill-out, and return one of the following forms via fax or e-mail:
Driver Evaluation Request (Word document)
Driver Evaluation Request (Mac/Pages Version)
Driver Evaluation Request ('PDF' document)
2 - Contact your physician and request a referral/prescription for a 'Drivers Evaluation'. Please print out the Physician Referral Form and provide it to the doctor. The return fax number is on the form.
3 - Review and return the following Client Consent & Release of Information Contract
Once the Physician Referral & Driver Evaluation Request are received you will be contacted to arrange an appointment date & time.
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.
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