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Use this form to request medical information from your physician, physician assistant or nurse practitioner 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the 'Customer Information' section. Enter your name, customer number or SSN, address, birth date, and contact details accurately.
- 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.
- 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.
- 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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