RDAC - Regional Driving Assessment Centre

Regional Driving Assessment Centre - driver assessment

Your feedback is very important to us

The information you provide will help us to ensure that we continue to provide the best possible service to our clients, their families and our supporters. If you have difficulty completing this form, please contact the Centre for assistance. Thank you for your time.

VISITORS BOOK

Form

Title

Mr Mrs Miss Ms Dr Other

Full Name

Address

Postcode

Telephone

Mobile

Which of these best describes why you have visited this site?
(tick all that apply):

Need Assessment	Need Information	Carer
Therapist	Doctor (G.P.)	Consultant / Surgeon
Mental Health Practitioner	Social Worker	Ophthalmologist
Driving Instructor / Driving Adviser	Charity Worker	Researcher
Garage / Adaptations company	Supporter or Sponsor	Forum Associate

Other - please specify:

Would you like to receive more information about RDAC?

(We produce a quarterly newsletter we can send you)

How did you hear about us?

Been before	Forum website	Disability group
Mobility Centre	Doctor	Solicitor & Insurance Co.
Driving Instructor	Social Worker/Social Services	DVLA
Publications and media	Friends or relations	Therapist
Garages/Modification firm	Other Charity	RDAC website

Other - please specify:

Would you consider donating to RDAC?

Your message (if any):

The Data Protection Act 1998 requires us to seek your written consent to our processing the information provided by you on this form.

Under the Data Protection Act you have the right to enquire, in writing, what personal information the Assessment Service is holding about you and, subject to a few limited exceptions, to be supplied with a copy of this information.

Thank you for your support