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Dmv eye test form 2026

The MV-619 Vision Test Report is a form used by vision test providers to report the results of a patient's vision examination to the New York State Department of Motor Vehicles (DMV). It is required for patients who visit non-enrolled providers in DMV's Vision Registry. The form includes instructions for both drivers and providers, detailing how to complete it, the validity period of the report, and information on corrective lenses. Providers must ensure accurate reporting and patient signature, while patients can use this report for license renewal applications.

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Click ‘Get Form’ to open the DMV Eye Test Report in our editor.
Begin by entering the patient's last name, first name, and middle initial in the designated fields.
Input the date of birth in the format Mo./Day/Yr. and select the patient's sex.
Fill in the patient's address, including street number, apartment number (if applicable), city, state, and zip code.
Record the date of examination and enter the best vision test score for each eye (right, left, both) as applicable.
Indicate whether corrective lenses were used to achieve a Snellen Test score of 20/40 by selecting 'YES' or 'NO'.
Have the patient sign their full name in box number 8.
The provider must complete their information in boxes 9 through 12, including signature and professional license number.

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Versions	Form popularity	Fillable & printable
2022	4.8 Satisfied (100 Votes)
2020	4.8 Satisfied (60 Votes)
2015	4.3 Satisfied (48 Votes)
2013	4.5 Satisfied (32 Votes)
2011	4.2 Satisfied (54 Votes)
2009	4 Satisfied (69 Votes)