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Book an Assessment

Use this form to book and pay for an Assessment

On completion of the form, a member of the Herts Ability team will confirm your booking with you.

Step 1

Please use the form to complete your details for your assessment. We will contact you shortly to confirm your booking with you.

Step 2

To help you on the day, please use the link below to give further details on your needs.

Pre-Assessment Form

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Landline Phone Number

Mobile Phone Number

Email *

Date of Birth

How did you find out about Herts Ability?

Licence Status

Provisional
Full
Expired

Has anyone referred you for an Assessment?

Have you informed DVLA of your medical condition?

What is your medical condition?

Do you use a wheelchair?

Can you transfer into a vehicle independently?

When did your last drive?

When did you last have your vision checked?

Do you wear glasses for driving?

What do you weigh? Use either:

Pounds and Stone
Kilograms

Stone

Pounds

Kilograms

Grammes

What is your height? Use either:

Feet and Inches
Centimetres

Feet

Inches

Centimetres

Would you like to drive a Manual or Automatic transmission vehicle?

Manual transmission
Automatic transmission

Do you believe that you will require adaptations in order to drive?

Yes
No
Not sure

If you currently use adaptations to drive please list them here:

Would you be interested in a cancellation if we get one?

Which Assessment Centre would you like your assessment to take place?

Welwyn Garden City
Luton
Watford
Harlow East London

Booking Time

Date

Time

Please choose a preferred date and time that you would like your assessment on. If the selected time is not available, we will contact you to arrange an alternative.

Herts Ability

Suite 4, Wentworth Lodge
Great North Road
Welwyn Garden City
Hertfordshire
AL8 7SR

Registered charity No. 1059015

Contact

01707 324581
01707 371297

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