Request for driver reexamination 2025

1. Click ‘Get Form’ to open the request for driver reexamination in the editor.
2. Begin by entering the name of the person being reported in the designated field, including their first name, middle initial, and last name.
3. Select the sex of the individual from the provided options.
4. Input the date of birth or approximate age in the corresponding section to ensure accurate identification.
5. If available, enter the driver's license number to assist in processing the request efficiently.
6. Fill in the street address, city, state, and zip code to provide complete contact information.
7. Clearly describe the underlying medical condition or diagnosis that warrants this reexamination request.
8. Ensure that a physician's signature is included along with their phone number and date. Select whether they are a physician, vision specialist, or other.
9. Once completed, save your document and follow instructions to mail or fax it to the DMV Medical Evaluation Program.

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