Older Driver Assessment Eligibility & Consent Form

Prestige Driving School offers Older Driver Assessments to help senior drivers keep driving safely and confidently. Please complete the form below to refer yourself or someone else for an assessment. Contact info@prestigedrivingschool.com.au if you have any questions or concerns.

Referral Information

Who are you referring?*
Myself
Someone else

Driver Information

Driver First Name *

Driver Last Name *

Date of Birth *

Email Address *

Phone Number *

Address *

Suburb *

State *

Postcode *

Licence Details

Driver Licence Number *

Licence Expiry Date *

Referrer Details (if applicable)

Referrer First Name

Referrer Last Name

Referrer Phone Number

Referrer Email Address

Relationship to Driver

Supporting Documents (optional)

Upload a referral letter or medical report if you have one

Choose File

Consent

The driver consents to the Older Driver Assessment and to Prestige Driving School collecting and storing the information in this form.*
Customer Agrees
Customer Disagrees

We can't proceed with the referral without consent. Please contact us if you have any questions.

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