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 complete this referral form but also contact your GP or Specialist to request they send this clearance via an online referral, email to info@otrs.co.nz or fax to 07 838 0152.

OTRS will contact you once the medical clearance has been received.

Medical Driving Assessment Referral Form

Name

Street Address

Town or City

Phone Number

Additional Contact Details: (Mobile Numbers and Email Address)

Date of Birth

Diagnosis (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

Name and relationship of person(s) completing this form

Contact details for person(s) completing this form (Phone Number, Mobile and Email)

Please tick if receipt of referral is required

Please add email address for receipt

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

Postal Address: PO Box 4138, Hamilton East

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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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