The purpose of this assessment form, is to ensure that both you as a service user and I as your Driving Instructor, are fully informed of any health conditions or concerns you have regarding personal safety during driving lessons. It is also to ensure any questions you have are answered and necessary planning and equipment are put in place before we commence driving Lessons.

If applicable, please take the time to discuss this form with your family members or those in your household before completing this form to ensure everyone in your home understands the questions and that your answers are accurate.

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PLEASE NOTE:

• YOU MUST NOTIFY ME IMMEDIATELY IF YOU OR ANY MEMBER OF YOUR IMMEDIATE HOUSEHOLD, SOCIAL CIRCLE OR WORK GROUP DEVELOP COVID-19 SYMPTOMS AND NEED TO SELF ISOLATE.

• FOR ADVICE ON COVID-19 SYMPTOMS VISIT https://www.nhs.uk/conditions/coronavirus-covid-19/

• YOU MUST NOT ATTEND ANY DRIVING LESSONS OR DRIVING TESTS IF YOU HAVE ANY COVID-19

      SYMPTOMS.

• YOU WILL NOT BE CHARGED A SHORT NOTICE CANCELLATION FEE, IF THE CANCELLATION IS DUE TO COVID-19. Lessons may only resume after self-isolation periods have been completed. 

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Please select 'YES' or 'NO' in each of the sections

If you answer ‘YES’, I will be in contact before your lesson. For you to provide further information -where necessary.

All questions need to be answered to proceed.