Driver Rehabilitation Services Referral Paperwork

Referral Forms Can Be Faxed To: (860) 631-1068

Download Our Referral Form

We require a referral form to be filled out and faxed through our secure, HIPAA Compliant fax line in order to begin driver rehab for a patient. The more thorough you are with your referral, the better and more specific our driving evaluations will be. 

DOWNLOAD OUR Referral Form

Join Our Referral Network

Do you have patients that may need driving rehabilitation services? If you will be referring patients to us, please fill out the form below. Our office will reach out to your office and we will add your practice information to our EMR for faster processing when patients call. We look forward to working with you and your patients.