Vehicle and passenger access assessment form


Whether you’re a professional, or an individual wishing to refer yourself for vehicle and passenger access assessment/support, please use our online referral form below:

Car seat assessments are no longer available at this centre. Please do not use this form, as requests will not be processed.

Your title: *
For example, 15 3 1984
Please select the support, advice or service we can help you with:
Can you weight bear?
Can you walk unaided?
Do you ever use a wheelchair or scooter either at home or out of doors?
Do you qualify for the Motability Scheme?
What type of problems are you experiencing? Please tick more than one if appropriate:
If applicable, please tick where are you accessing your vehicle?
Referring professional’s title (if applicable):
Has the referrer completed any cognitive testing with the individual:
Could you take a short notice appointment?
If English is not your first language, do you require an interpreter?
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