Case Manager Form

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    Referrer

    Invoice details

    Client

    Alternative Contact Details

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

    Medical Condition

    [check* referral-for include_blank "Car Assessment" "Motorbike Assessment" "HGV/LGV/PSV Assessment" "Vehicle Access Assessment/wheelchair stowage" "Powered Wheelchair and Mobility Scooter"]

    The assessment fee is £150 + VAT. To avoid the full fee being applied to cancellations, RDAC should be notified as soon as possible, with a minimum requirement of five clear working days' notice, excluding weekends and bank holidays, if the appointment needs to be rescheduled. If your client fails to attend the assessment, the full fee will be charged along with any additional fees to hire vehicles, instructors, and equipment.

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

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