Thank you for your enquiry

Please check your email and junk folder as we will automatically respond to this.

Close

NHS Referral Form

If you are having difficulties with the form, you may need to contact your IT manager to adjust firewall settings.

    1

    2

    3

    4

    5

    6

    Patient

    Alternative Contact Details

    Referrer

    Licence Status

    PLEASE NOTE THE PATIENT MUST HOLD A VALID LICENCE TO HAVE A DRIVING ASSESSMENT

    (please ensure your patient has informed the DVLA of any notifiable condition)

    Please advise your patient that if they do not meet the visual standard for driving (reading a number plate at 20 meters), the DVLA will be informed, and this could likely result in their licence being revoked.

    Medical Condition

    If a health professional has advised your patient to stop driving, unfortunately, we will not be able to conduct an assessment without their agreement.

    Please note, if your patient isn't ready for an assessment within the next 3 months, you will need to refer them closer to the time.

    GP Details

    (If no, please provide details as to why.) Please note that if your patient isn't ready for an assessment within the next 3 months, you will need to refer them nearer the time.

    Booking Information

    Upon receipt of your referral, RDAC will contact your patient to arrange an appointment

    For more details on how we handle your data, please view our Privacy Policy.

    rdac logo

    0300 300 2240

    feedback@rdac.co.uk

    Contact