Please click the download to view the Medical Fitness to Drive Consent Form

Click here to download pdf

Get in touch:

Phone: 0800 687 748

Fax: 07 838 0152

Email: info@otrs.co.nz

Address: Hamilton

Suite 3, Level 1

169 London Street,

Hamilton Central, 3204

Contact Us

Terms Of Use Privacy Policy

For clinicians only:

Make a referral:

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 or MINI ACE score and current medications list) GP please email these to 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 or a copy of the 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.

Please click the download to view the Medical Fitness to Drive Consent Form

Get in touch:

For clinicians only:

Make a referral:

This product has been added to your cart