Dubbo Regional Occupational Therapy (DROT)

Driving Assessment Referral

Dubbo Regional OT will contact you once your referral has been received to discuss the Driving Assessment process and costs involved.

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Client First and Last Name

Client Date of Birth

Client Address

Client Contact Number and Email

Client Alternative Contact Name and Contact Details

Referred By (Name and Organisation)

Referrer Contact Number and Email

Drivers Licence Number

Auto/Manual Assessment

GP Medical

Transport for NSW Letter

I acknowledge that DROT requires a letter from my GP advising the reason for a driving assessment and that a Health Summary is to be supplied to DROT prior to an assessment being booked.

I consent for DROT to discuss my driving assessment with my GP prior to assessment if required

I agree to forward a copy of my letter from Transport for NSW and Drivers Licence to admin@drot.com.au to proceed with this referral