Guidelines for Submitting a Referral

GP's or Specialist's making a referral for a driving assessment

Please provide our team with any medical information that may be relevant to a client's safety to drive. If you wish to provide documents with this referral, please either email these to info@otrs.co.nz or fax them directly to 07 838 0152 once you have submitted the referral form below.

General Public making a referral for a driving assessment

OTRS requires medical clearance to progress with a driving assessment. Please contact your GP or Specialist to request they complete an online referral,

OTRS will contact you once the referral has been received to make an appointment.

Medical Driving Assessment Referral Form

Patient Name

Street Address

Town or City

Phone Number

Additional Contact Details: (Mobile Numbers and Email Address)

Date of Birth

Diagnosis

Reason for referral (please include MOCA score, Visual Field Tests and Current Medications) GP please email info@otrs.co.nz or fax any other relevant information to 07 838 0152

Additional Comments or Concerns

GP or Specialist Name and Designation

Clinic or Practice Name

GP or Specialist email address

GP or Specialist Contact Number

Please tick if receipt of referral is required

Address

Thank you, your referral has been sent successfully and the OTRS Team will be in touch to arrange your assessment. A report will be sent once the assessment has been completed.

Contact OTRS

Phone: 0800 687 748

Fax: 07 838 0152

Email: info@otrs.co.nz

Address: Suite 3, Level 1

169 London Street,

Hamilton Central, 3204

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Guidelines for Submitting a Referral

GP's or Specialist's making a referral for a driving assessment

General Public making a referral for a driving assessment

Medical Driving Assessment Referral Form

Contact OTRS

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