Referral form

The following link will take you to our referral form. We are still trialling this new way of doing our referral forms, so if you come across any difficulties or have any feedback, please let us know so we can fix and improve the form.

 

In addition to completing our referral form, would you please also complete our driving assessment data collection form to provide some information about your driving history and the limitations your disability may cause.

Information about the assessment

Upon receiving your completed referral and driving assessment information collection forms, we will send a request for signature for an informed consent form which includes:

  • Information about the driving assessment (please read through this document)

  • Informed consent form, which will need to be signed on the day of the assessment

Fitness to drive medical forms

Below, are several downloads with ‘Fitness to Drive’ medical forms:

  • Transport for NSW medical form, which needs to be completed by a doctor, returned to me and processed by Transport for NSW before the assessment can be booked in

  • Letter addressed to your doctor, explaining how to complete the Transport for NSW medical form and requesting a GP referral

  • Specialist medical form, which needs to be completed by your specialist, returned to me and processed by Transport for NSW before the assessment can be booked in

 

Only one of the medical forms needs to be completed by either a GP or treating specialist. When completing the form, please ensure that the professional is completing the correct medical form as the completion of the wrong form can cause delays in receiving approval from Service NSW that the assessment is able to proceed.

 

The ‘NSW Fitness to Drive’ medical form is valid for 6 months from the date of completion. If your ‘Fitness to Drive’ form is older than 6 months at the time of your assessment, Service NSW will not accept the form as valid, and a new form will need to be completed before the assessment can be completed.

 

Assessment location

The assessment will take place at your home.

 

Information I need

Please send back (by email to admin@wiseot.au, fax or regular post):

  • Referral form (which will be automatically emailed to us once it is completed)

  • Photos of both sides of your licence card

  • Completed Transport for NSW medical form

  • A GP referral, which includes a health summary/history