Use this form to request medical information from your physician, physician assistant or nurse practitioner 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Customer Information' section. Enter your name, customer number or SSN, address, birth date, and contact details accurately.
3. In the 'Medical Condition' section, provide a detailed description of your medical condition and any medications you are taking. Be sure to indicate if you have experienced any significant episodes like blackouts or seizures.
4. Complete the 'Information Release Approval' section by authorizing your medical provider to fill out the necessary parts of the form. Don’t forget to sign and date this section.
5. Once completed, take the entire MED 2 form along with your DMV letter to your healthcare provider for them to fill out their sections.

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