Driver Evaluation Registration

Use the form below to register for a Driver Evaluation. If you have any questions please feel free to reach out to a school staff member for assistance at (770) 800-5751.

Student Contract Number

The below form will register you for the CODE (Certified Older Driver Evaluation) program or CCDE (Certified Comprehensive Driver Evaluation) program. Driver Evaluations comprehensively assess your driving skills and provide a score and feedback from a Driving Evaluator.

Any individual can take a driver evaluation at any time, but these evaluations are often requested by doctors, physical or occupational therapists, friends and family members, churches, courts or other government organizations to help drivers determine their current ability to safely operate a motor vehicle.

The cost of a Driver Evaluation is $297. Every Driver Evaluation has a clinical component that is typically covered by the driver's insurance.

Driver Information

Student Name(Required)

First Last

Date of Birth(Required)

Phone(Required)

Email(Required)

Student Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Are you age 65 or over?(Required)

Yes

Do you currently have a valid driver's license or ID?(Required)

Yes

Driver's License/ID Number(Required)

Driver's License/ID Expiration(Required)

Driver's License/ID Issue Date(Required)

Upload Drivers License

Max. file size: 128 MB.

Trusted Friend or Family Member Contact

Prior to your on the road Driver Evaluation, you will need to fill out some information about your health, prescriptions and other details. Do you have a friend, family member, or adult child that can assist you in filling out information?

Yes

Contact Name(Required)

First Last

Relationship(Required)

Contact Phone Number(Required)

Contact E-mail Address(Required)

Do you have an additional contact you'd like to add?

Yes

Contact Name(Required)

First Last

Relationship(Required)

Contact Phone Number(Required)

Contact E-mail Address(Required)

Referral Information

Who referred you to your Driver Evaluation?(Required)

Self Referral

Doctor / Physician

Occupational or Physical Therapist

Family

Friends

Church or Other Religious Organization

Insurance Company

Other

Name of Referrer(Required)

Referrer Phone Number(Required)

Referrer Fax Number

Referrer E-mail Address

Organization Name (if any)

Have you already completed any kind of clinical test specifically for driving with an occupational therapist, physical therapist or neurologist?(Required)

Yes

Send a copy of the Driver Evaluation results to this referrer?(Required)

Yes

Optional Service: Help Filling Out Forms (FREE for 2024)

Prior to your on the road Driver Evaluation, you will need to fill out some information about your health, prescriptions and other details. This is called the Questionnaire portion of the evaluation, and typically takes about 1-2 hours when completed at home. Most drivers either complete this themselves, or with the help of a friend or family member, often an adult child. For a fee, you can also set an appointment with our staff and complete the questionnaires at the school. You'll need to bring a list of your prescriptions.(Required)

(Optional Fee) Would you like to set an appointment to fill out paperwork with our staff?

Yes, I would like help filling out forms: $FREE FOR 2024 (Saves $35)

No, I will complete the questions at home myself or with a friend/family member.

Discounted Behind the Wheel Refresher Course

Often, what is seen as driver problems can simply be bad driving habits that can be corrected with training prior to the Driver Evaluation. We strongly recommend those seeking a Driver Evaluation to spend 2-4 hours (1-2 driving sessions) with a licensed instructor to get up to speed on the best driving practices prior to the evaluation itself.

No Refresher Prior to Evaluation

2 Hour (1 Session) On the Road Refresher: $150.00

4 Hour (2 Sessions) On the Road Refresher: $265.00

6 Hour (3 Sessions) On the Road Refresher: $365.00

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Drivers Education Terms of Agreement

The student's successful completion of the above-named course requires each of the following:
1. Punctual attendance for all sessions.
2. Reasonable attentiveness and participation in all classes.
3. Makeup classes for missed sessions.
4. Successfully passing a written examination with a grade of at least 70.

The Driver Training School will not refund any tuition or part of tuition if the School is ready, willing, and able to fulfill its part of this contract. I understand that if I fail to comply with the terms and conditions of this agreement, I am in breach of contract and the school will not be under any obligation to fulfill the terms of this contract, and may, at its option, terminate this agreement immediately. Instruction must be completed within six (6) months.

It is agreed that an owner, instructor, or employee of this Driver Training School shall not give the impression directly or implied to a student that upon completion of the course the student will receive a license to operate a motor vehicle. However, immediately upon the student's completion of the course as described above, the Driver Training School agrees to provide certification of said completion to the student.

This Driver Training School has and will maintain for the protection of the contractual rights for the student a performance bond in the principal sum of twenty-five hundred ($2,500.00 dollars) for the students to be written by a company authorized to do business in the State of Georgia.

10% of tuition is a non-refundable deposit. If a portion of instruction has taken place, the entirety of the tuition is non-refundable. Classroom course dates can be re-scheduled a total of two (2) times during the 6-month instruction window. Cancellations that occur within 24-hours of a scheduled appointment, or during the preceding business day, require re-payment for the number of cancelled sessions.

This agreement constitutes the contract between the above named Driver Training School and the above-named student and no verbal statements will be recognized.

I agree to the Terms of Agreement for Drivers Education(Required)

Yes

To perform your refresher course, we will need a copy of your drivers license. You can upload it below or email a photo of your license to staff@westmetrodriving.com

Max. file size: 128 MB.

Payment Information

Pay for class

Price:

Total

Credit Card Information

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Signature Confirmation

Signature(Required)

I, the above signed Driver, affirm that I am above 18 years of age, the above information is accurate to the best of my knowledge. I understand that the Driver Evaluation must be completed with my cooperation, and any fees paid are not refundable once I have registered for this program.(Required)

Yes

Driver Evaluation Registration

Driver Information

Trusted Friend or Family Member Contact

Referral Information

Optional Service: Help Filling Out Forms (FREE for 2024)

Discounted Behind the Wheel Refresher Course

Drivers Education Terms of Agreement

Payment Information

Signature Confirmation

Driver’s Education

Defensive Driving

Company