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The Class D and M Vision Screening Certificate is a form required for applicants seeking a learner's permit or driver's license in Massachusetts. It must be completed by a licensed ophthalmologist or optometrist, detailing the applicant's vision acuity and field of vision. The document outlines specific visual standards necessary for obtaining a license, including requirements for corrective lenses and bioptic telescopic lenses. It also includes sections for professional recommendations regarding re-evaluation and conditions for maintaining the validity of the certificate.

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Click ‘Get Form’ to open the Class D and M Vision Screening Certificate in the editor.
Begin by filling out the Applicant Information section. Enter your last name, first name, middle name, suffix, Massachusetts Driver’s License number, and phone number. Don’t forget to sign and date the form.
In the Vision Screening Data section, provide visual acuity measurements for both eyes without and with corrective lenses. Ensure you follow the guidelines regarding qualifiers.
Answer all questions regarding glasses or contact lenses needed for driving, monocularity, and bioptic telescopic lenses. Be sure to check 'Yes' or 'No' as required.
Complete the Vision Screening Analysis section by confirming whether you meet the minimum visual standards required by Massachusetts. The ophthalmologist or optometrist must also sign this section.

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