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- Click ‘Get Form’ to open the DL-121 form in the editor.
- Begin by filling out the 'Patient Information' section. Enter the driver's license number, height, sex, last name, eye color, date of birth, telephone number, first name, email (if applicable), and complete address including city, state, and zip code.
- Proceed to answer the questions regarding the patient's medical history. Provide details on how long you have been treating the patient and whether they have experienced seizures. Be sure to include dates where applicable.
- Continue through the form by answering questions about EEGs, medications affecting driving ability, and any episodes of loss of consciousness. Ensure all fields are completed accurately.
- In the 'Health Care Provider Information' section, input your name, contact details, license number, specialty, and address. Finally, sign and date the form to confirm accuracy.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2012 | 4.8 Satisfied (67 Votes) |
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