Mobility scooter advice – Drive Ability North West

Mobility scooters provide many people with the freedom to live the life they want.

Our Occupational Therapists will give you all the advice and information you need, as well as assessing which mobility scooter might best suit your needs.

We’ll put you at ease during your assessment, which will include:

• Understanding of your current mobility
• Current medical history and eyesight
• Height, weight and seated measurements
• Understanding your seating and comfort requirements
• Where the equipment will be used?
• How far would you like to travel?
• How will the equipment be transported?
• Understanding your ability to self-propel or drive equipment
• Will you be assisted? Understanding your carers’ needs
• How will you access or fund equipment?
• An equipment trial

How do I apply for an assessment?

Simply fill in our online Referral Form at the bottom of this page, or call us on 01942 483 713.

“Excellent service. Very helpful!”

Drive Ability North West service user

Scooter Assessment Referral Form

Whether you’re a professional, or an individual wishing to refer yourself for scooter assessment, please use the form below.

Individual's title: *-MrMissMrsMsOther

Individual's name: *

Individual's date of birth (DOB): *

Individual's telephone: *

Individual's email:

Individual's address: *

Individual's postcode: *

Individual's emergency contact name: *

Individual's emergency contact telephone: *

If you have a medical condition/diagnosis please give brief overview:

Reason for assessment:

Does the individual already have a scooter or use of one?

• Yes
• No

If yes, please provide the details here:

What type of scooter is the individual hoping to obtain:

• 4 mph scooter (pavement use)
• 8 mph scooter (for on road use)
• Other

If other, please state:

Would you need the scooter to be transportable in a vehicle? -YesNo

Referring professional’s title (if applicable):-MrMissMrsMsDrOther

Referring professional’s name and designation:

Referring professional’s email:

Referring professional’s telephone:

Referring professional’s address:

Referring professional’s postcode:

Trust/Hospital/Service:

Has the referrer completed any cognitive testing with the individual?-YesNo

If you have selected yes, please give details in the box below (tests used, score, etc):

Referring professional’s referral reason and additional information: (copy)

Privacy policy *

• I confirm that I have read and I consent to Bridgewater's privacy policy

Submit

Please note: If you want a copy of your referral please save your details before pressing submit. We are unable to send copies of the referral once submitted.

We will use your address to ensure that we are your closest Driving Mobility centre.

If there is a centre closer to you, you will be given the opportunity to select this one.