Med 4 customer vision report 2010 form-2025

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The MED 4 form is a Customer Vision Report used to request vision examination information from an ophthalmologist or optometrist for DMV purposes. It requires the customer to provide personal information and have their eye care provider complete a vision examination section, which must be conducted within 90 days prior to submission. The report outlines vision standards for driving eligibility and includes instructions for mailing the completed form to the DMV.

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Click ‘Get Form’ to open the med 4 customer vision report 2010 form in the editor.
Begin by filling out the Customer Information section. Enter your last name, first name, middle initial, and suffix as required. Provide your customer number or SSN, residence/home address, and check the box if this is a new address.
Next, input your daytime telephone number and mailing address if it differs from your home address. Ensure all information is accurate before proceeding.
Once you have completed your section, print the form and have your ophthalmologist or optometrist fill out the Vision Examination section. They will need to provide examination dates and visual measurements.
After both sections are complete, review the document for any errors. Use our platform’s editing tools to make necessary adjustments before finalizing.
Finally, save your completed form and follow the instructions to mail it to the appropriate DMV address.

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See more med 4 customer vision report 2010 form versions

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (121 Votes)
2016	4.4 Satisfied (117 Votes)
2010	4.4 Satisfied (62 Votes)

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