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Referral Instructions

We welcome online referrals from Specialist Doctors and General Practitioners. This form allows for the secure and efficient transmission of clinical information required for driving assessments. Once submitted, our team will review the details and contact the client directly to schedule an appointment.

Note: All fields marked with * are required. The form is securely submitted to info@drivinghealth.com.au

Rehabilitation Physicians
Single choice
Dr Su-Min Wong
Dr Kandegama Subha Senewirathna
Occupational Therapist Driver Assessor
Single choice
Ms Nicki Hayball

Client Details

Date of Birth
Day
Month
Year
Gender
Male
Female
Other

Alternate Contact Details

Reason for Referral

Priority
Urgent
2-4 Weeks
Not Urgent
Licence Status
Suspended
Current
Current, but advised not to drive

Medical History/Medications

Referring Doctor Details

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Additional Information

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