Dmv medical review request form 2026

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Click ‘Get Form’ to open the DMV Medical Review Request Form in our editor.
Begin by filling out the DRIVER INFORMATION section. Enter the driver's name, gender, DMV customer number, vehicle plate number, birthdate, and telephone number. Ensure all information is accurate.
Next, provide the RESIDENCE/HOME ADDRESS and MAILING ADDRESS if different. This includes city, state, and zip code for both addresses.
In the REQUESTER INFORMATION section, indicate which tests you believe the driver should undergo by checking the appropriate boxes for Medical Examination, Vision Examination, Knowledge Examination, or Road Skills Test.
Describe in detail the circumstances that led to this request. Include any observations regarding the driver's mental, physical, or visual impairments. Use an additional sheet if necessary.
Complete the REQUESTER NAME and other contact details including badge number and organization name. Don’t forget to sign and date the form before submission.

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