Dr2402 2026

1. Click ‘Get Form’ to open the dr2402 in the editor.
2. Begin by filling out the Driver/Patient Section. Enter the patient's last name, first name, middle initial, street address, city, state, ZIP code, customer identification number (CIN), and date of birth.
3. Review the Driver Statement of Understanding. Ensure that the patient understands their responsibilities regarding the eye examination and sign where indicated.
4. Proceed to the Ophthalmologist/Optometrist/Physician Section. The physician should complete all sections based on their clinical judgment and assessment of the patient's visual capabilities.
5. Check all applicable conditions under Examination Information and provide distance acuity measurements for both eyes with and without correction.
6. Indicate any recommended license restrictions based on your observations and complete the physician's information at the bottom of the form.

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