Physician Certification for Blind or Disabled Person, 2025

1. Click ‘Get Form’ to open the Physician Certification for Blind or Disabled Person in our editor.
2. Begin by filling out the 'Applicant Information' section. Clearly print your Driver License Number (if applicable), First Name, Middle Name, Last Name, Date of Birth, Address, City, State, and Zip Code.
3. Next, move to the 'Physician’s Information' section. Enter the Physician’s Name, Medical License Number, State of Issuance, Address, City, State, and Zip Code.
4. In the certification area, provide a detailed explanation of the applicant's condition. Ensure that this is printed clearly for accuracy.
5. Finally, have the physician sign in the designated area to complete the form. This signature is essential for validation.

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