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Form dl 129 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the patient information. Fill in the driver's license number, height, sex, last name, first name, eye color, date of birth, telephone number, and email if applicable.
- Complete the street address section accurately. Remember that a P.O. Box can be included but cannot be the only address provided.
- In the medical history section, detail how long you have been treating the patient and list any diagnosed diseases or conditions.
- Answer questions regarding episodes of loss of consciousness or awareness. Provide dates for any episodes and describe diagnostic tests performed along with their results.
- Indicate whether the patient is on medication and if it affects their ability to drive safely. Provide additional details as necessary.
- Finally, fill in your health care provider information including your name, specialty, license number, address, and contact details before signing and dating the form.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2012 | 4.8 Satisfied (266 Votes) |
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