How to Make a Referral

STRIVE for Independence is staffed with occupational therapists who are also Certified Driver Rehabilitation Specialists who have years of experience working with clients across age groups, disabilities, and conditions.

If you would like us to contact the patient/client/student/ parent (or guardian) to schedule, please include contact information (phone and email).

Please fax all orders, authorizations, and vouchers to 630-984-1919 or email them to info@striveforindependence.org .  Thank you.

Driver Ed Referrals

For Physicians

To refer a client, please send us an order (either on a prescription pad or by using this form) and include the following information:

  • Name and DOB
  • "OT Driver Evaluation and Treatment"
  • Diagnosis
  • Sign and date
  • Fax or email for us to send you a copy of the evaluation and care plan

For School Districts

To refer a student, please send us a letter of authorization (either on school letterhead or using this form) for payment of services and include the following information:

  • Name and DOB
  • Diagnosis or reason for referral
  • Sign and date by an authorized representative
  • Contact information including name and fax/email for where you would like us to send a copy of the reports and invoices
  • Date when the letter of authorization will expire (one year from the date of the letter, date of student's graduation, etc.) 

To cover a student's services, these fees need to be authorized prior to service but can be billed after date of service.  (Please note that self pay prices listed elsewhere reflect a discount based on paying prior to and on the date of service.)

  • Full car evaluation: $610
  • Full van evaluation: $900
  • Readiness evaluation: $360
  • Behind the wheel car evaluation: $360
  • Behind the wheel van evaluation: $650
  • Behind the wheel training: $210 per hour
  • Travel: $150 per hour

For DRS Counselors and Work Comp Representatives

To refer a client, please send us a voucher for authorization for payment of services and include the following information:

  • Name and DOB
  • Diagnosis or reason for referral
  • Sign and date
  • Fax or email for us to send you a copy of the reports and signed vouchers/invoices

To cover a client's services, these fees need to be authorized prior to service but can be billed after date of service.  (Please note that self pay prices listed elsewhere reflect a discount based on paying prior to and on the date of service.)

  • Full car evaluation: $610
  • Full van evaluation: $900
  • Readiness evaluation: $360
  • Behind the wheel car evaluation: $360
  • Behind the wheel van evaluation: $650
  • Behind the wheel training: $210 per hour
  • Travel: $150 per hour