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(We may need contact your GP prior to your appointment)

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For your appointment

  • Please remember to bring your national insurance number and driving licence with you.
  • Check you can read a number plate from 20 meters (65 feet) away. If you struggle with this let us know.
Are you able to attend at short notice Required

About your general health/Medical condition(s) and Vision

Have you or are you experiencing any of the following:
Do you have any problems with your vision?
Do you have any problems with your mobility?

About your licence

Please tick one of the following that best applies to you Required
Your Licence Status Required
Have you informed the DVLA of your medical condition?

If you are not sure if you need to notify the DVLA check the medical fitness to drive guidelines on the DVLA website.

Codes can be found on the back of your licence under in section 12.

About your driving

Has a health professional advised you not to drive?
Manual or automatic?
Do you have any adaptations fitted to your car?
Do any of the following apply to you?
Have you been convicted of a driving offence in the last 5 years including speeding?
Have you had a road traffic collision or any near misses in the last 3 years?
What types of vehicles do you have experience driving?

Consent

Your appointment will include:

  • Asking you about your medical history and driving history.
  • A clinical assessment including physical movements, vision and thinking skills.
  • An assessment of your driving safety

If you feel unwell or want to stop the assessment for any reason you can do so.

The possible outcomes are:

  • Safe drive
  • Unsafe drive
  • Tuition is required.

If the outcome is that you are unsafe to drive you must stop driving immediately and we will ask you to surrender your licence. From this point you will not be covered by your insurance and in the interests of road safety staff may contact the DVLA. If you are unsuccessful you will be offered support regarding going car free by the transport HUBs service.

Information will be shared with:

  • DVLA referrals: The DVLA will be notified of the outcome and a copy of your report will be forwarded. The final decision regarding your licence will be made by the DVLA.
  • All other referrals:  The referrer will be notified of the outcome and a copy of your report may be forwarded to the person who referred you and your GP. You will be sent two copies of your report please send one to the DVLA. 
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Service monitoring

As part of our aim to reach everyone in the community, we would be grateful if you would complete these questions on the final page of this questionnaire.

Please tick one of the following for monitoring purposes
I do not wish to respond to the above information
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