/MM/DD) E-MAIL / BC Driver s Licence Number / BC TELEPHONE (HOME) BC TELEPHONE (WORK / CELL) MAILING ADDRESS CITY PROVINCE POSTAL CODE Responsible Driver Program Requirements I have been referred by RoadSafetyBC to the Responsible Driver Program (the Program ), administered by Stroh Health Care Consulting Corporation ( Stroh ). My participation in this program is to enable the Superintendent of Motor Vehicles to determine my fitness to drive. I acknowledge that this program.

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How to fill out the Canada Stroh Health Care Responsible Driver Program Registration and Informed Consent online

Completing the Canada Stroh Health Care Responsible Driver Program Registration and Informed Consent online is a straightforward process that enables you to register for the program designed to assess your fitness to drive. This guide will provide clear step-by-step instructions to help you efficiently fill out the required form.

Follow the steps to accurately complete your registration.

  1. Click ‘Get Form’ button to obtain the form and open it for editing.
  2. Begin by filling in the registration information. Mandatory fields include your surname, given names, date of birth (formatted as YYYY/MM/DD), email address, BC driver’s licence number, home telephone number, work or cell phone number, mailing address, city, province, and postal code. Ensure to print clearly and use black or blue ink.
  3. Proceed to the section titled 'Responsible Driver Program Requirements.' Here, you need to acknowledge your referral by RoadSafetyBC and your understanding that the program may take up to nine months to complete.
  4. In the 'Consent to Release Information' section, confirm that you consent to RoadSafetyBC providing your driving record and agree to Stroh collecting your personal information related to the program.
  5. Fill out the 'Acknowledgement and Consent to Program Requirements.' This includes understanding the nature of the initial screening and assessment process which will be used to determine the appropriate program for you.
  6. Next, locate the 'Program Cost' section. Here, affirm your agreement to pay the prescribed program fee of $930.00, ensuring you understand the payment conditions.
  7. Select your preferred method of payment. You can choose between cheque, money order, or credit card authorization. Ensure to check the appropriate box depending on your choice.
  8. If paying by cheque or money order, prepare to mail your completed registration package to the specified address. If paying by credit card, you may fax your registration package or mail it.
  9. Provide your contact preferences for telephone contact by checking the appropriate options for home, work, email, or other.
  10. Finally, complete the client signature and date sections at the bottom of the form to acknowledge your understanding and consent to participate in the program.
  11. Once completed, you can save your changes, download, print, or share the form as needed.

For a smoother registration process, complete your documents online with the provided guide.

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Canada Stroh Health Care Responsible Driver Program Registration And Informed Consent Form

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