PROCEDURE FOR DRIVER REHABILITATION REFERRALS
 
            In order for our facility to provide the best possible service to your client, it is important for us to have complete    information.  Below are listed our referral information requirements.  All of these forms will be provided by the Center.

  Information from the referring agency or facility:

 1.     Completed client referral form

 2.     History and Current Status Form

 3.     Relevant client case file information from the previous 12 months (visual-perceptual, cognitive, neuropsychological, and physical examination; work history, etc.

  Information from the client:

  1.    Completed Driver Pre-Assessment Form

  2.    Driver Assessment and Education Contract

  3.    Photocopy of Valid Learner's Permit or Operator License

  4.    Vehicle Information Form

  Information from the physician:

  1.    Complete Medical Form

            Note:  This form must be completed and signed by the physician, and must include an indication of the physician's opinion regarding the client fitness for operating a motor vehicle.

 
For more information contact:

      Kitty Carter
      Services Secretary
      Center for Rehabilitation Science
      and Biomedical Engineering
      Louisiana Tech University
      P.O. Box 3185
      Ruston, LA 71272
      (318) 257 - 4562

Click here to download a referral packet