Additional software may be required to download and view forms in PDF format. Click here to download Adobe Acrobat PDF Reader.
Forms may be downloaded, completed and faxed to DRS office at 336-697-7842.
Referral from a Physician’s Office
Referral from a Vocational Rehabilitation Services or Independent Living Program Counselor
Referral from a Worker’s Compensation Case Manager or Adjuster
Referral of self from an Aging Driver or Aging Driver’s Family Member
Referral of a Special Needs Teen Driver
Release of Information
Client Contract
Referral Forms
Forms may be downloaded, completed and faxed to DRS office at 336-697-7842.Referral from a Physician’s Office
Referral from a Vocational Rehabilitation Services or Independent Living Program Counselor
Referral from a Worker’s Compensation Case Manager or Adjuster
Referral of self from an Aging Driver or Aging Driver’s Family Member
Referral of a Special Needs Teen Driver
Service Contract & Consent to Release Information Forms
These forms are for viewing purposes only. Please DO NOT fax or email to DRS office. Digital copies of these forms are signed by the client prior to service delivery.Release of Information
Client Contract
Directions to Driver Rehab
Directions to Driver Rehabilitation Services
Additional software may be required to download and view forms in PDF format. Click here to download Adobe Acrobat PDF Reader.Referral Forms
Forms may be downloaded, completed and faxed to DRS office at 336-697-7842.-Referral from a Physician’s Office
- Referral from a Vocational Rehabilitation Services or Independent Living Program Counselor
- Referral from a Worker’s Compensation Case Manager or Adjuster
- Referral of self from an Aging Driver or Aging Driver’s Family Member
- Referral of a Special Needs Teen Driver
Service Contract & Consent to Release Information Forms
These forms are for viewing purposes only. Please DO NOT fax or email to DRS office. Digital copies of these forms are signed by the client prior to service delivery.- Release of Information
- Client Contract