Ohio 2026

1. Click ‘Get Form’ to open the Ohio Request for Statement of Physician in the editor.
2. Begin by entering the patient’s first and last name, address, city, state, ZIP code, and date of birth in the designated fields.
3. Provide the patient’s phone number and check the box if there is a name or address change.
4. In the Release of Information section, authorize the release of medical information by signing and dating where indicated.
5. Complete the Physician’s Statement section by answering whether previous physician records are available and providing details about any other treating physicians.
6. Indicate any medical conditions that may affect driving ability by checking 'Yes' or 'No' for each listed condition. Provide explanations as required.
7. Fill in how long each condition has existed and provide details on medication adherence and driving capability assessments.
8. Finally, ensure all sections are completed accurately before saving your document for submission via mail, email, or fax as specified.

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