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Follow Up PAQ

This follow-up Pre-Assessment Questionnaire is focused on any changes since your last assessment.

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Personal Information

Title *

For example, Miss, Mr, Mx, Dr.

Name *

First

Last

Email Address

Confirm Email

Phone Number *

2a. your Please

Since your last assessment...

1. Have you been told by the DVLA or a medical professional that you should cease driving? *

2. Has your medical condition changed? *

2a. If you answered 'Yes' please explain:

About your driving...

3. Was it recommended that you undertake tuition? *

If you answered ‘No’ please go to Question 7.

3a. Was the car Manual or Automatic? *

Manual
Automatic

3b. Which adaptations did you use? Please list them here.

For example a steering wheel adaptation.

4. How many hours of tuition have you had? *

5. When was your last lesson or when is your last lesson before assessment?

Click or tap to choose a date.

6. Does your Driving Instructor feel you are at a safe standard of driving? *

Please add any comments regarding your tuition.

Since your last assessment...

7. Have you driven independently (without a supervising driver)? *

Please add any comments regarding your driving experiences.

Additional Information

8. We will need to check your driving entitlement before your assessment.

To do this, we require your National Insurance Number.

This will be deleted from our files once your assessment is completed.

Please provide your NI number below. *

Use the format 'AB 12 34 56 C

9. Please add any comments or concerns regarding your assessment.

Declaration

I hereby declare that all the above information is correct to the best of my knowledge.

Signature *

Clear Signature

Date *

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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