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Dmv medical evaluation form 2025

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The document is a Driver Medical Evaluation form used by the California Department of Motor Vehicles (DMV) to assess a driver's medical fitness to operate a vehicle. It includes instructions for both the driver and their medical professional, requiring detailed health history and evaluations related to various medical conditions that may impact driving safety. The form emphasizes confidentiality of medical information and outlines the responsibilities of both parties in providing accurate health assessments.

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Click ‘Get Form’ to open the DMV Medical Evaluation form in the editor.
Begin by filling out Section 1, which includes your personal information such as name, address, and driver license number. Ensure all details are printed legibly.
In Section 1, answer the health history questions honestly. If you answer 'YES' to any question, provide a detailed explanation in the space provided.
Proceed to Section 2 and read the advisory statement carefully. This section outlines the importance of providing accurate medical information.
Complete Section 3 by authorizing your medical professional to share relevant health information with the DMV. Sign and date this section.
Once you have completed Sections 1-3, print the form and take it to your medical professional for them to fill out Sections 5-13.

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Versions	Form popularity	Fillable & printable
2020	4.9 Satisfied (46 Votes)
2010	4.2 Satisfied (53 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What are your evaluations as a driver?

A driver evaluation is an assessment of the physical and cognitive skills necessary to safely drive a car. If you have a physical or cognitive limitation that impacts your ability to drive, your driver assessment can help you to regain your driving privileges.

What does a driver evaluation consist of?

The clinical evaluation includes assessment of physical, visual, cognitive, and behavioral abilities. If adaptive driving equipment is required, we have vehicles with different control options, multiple steering orthotics, a left foot accelerator and pedal extensions of various lengths for trial.

How do you evaluate driver performance?

Driver scoring is a comprehensive evaluation of driver behavior and performance calculated from metrics like speed, harsh braking, rapid acceleration, idle time and even adherence to traffic rules.

What is the fax number for NC DMV medical review?

To request reconsideration, you must submit a signed, written request to the Medical Review Board, 3112 Mail Service Center, Raleigh, NC, 27699-3112 or fax to the NCDMV Medical Review Board at (919) 733-9569.

How do you evaluate a good driver?

Critical driving skills and knowledge areas are fundamental to any driver assessment. This encompasses a drivers ability to navigate various traffic conditions, knowledge of road signs, and understanding of laws and regulations.

dmv physician reporting form california

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What to do with a D4 medical form?

Check all sections of the medical report have been fully filled in. If you send us an incomplete report your application will be returned. Send the filled in D4 (vision and medical assessment) with your application form and driving licence to DVLA, Swansea, SA99 1BR.

Where do I send CA DMV forms?

Form Reproduction Contacts Form TypeAddress Form TypeDriver Licensing (DL) Financial Responsibility (SR) AddressDMV Policy Division 2570 24th Street, MS J163 Sacramento, CA 95818 (916) 657-5691 Form TypeField Operations (FO) AddressDMV Field Operations Division 2415 First Avenue, MS F106 Sacramento, CA 95818 (916) 426-07261 more row

What is driving evaluation?

This typically includes an interview to determine medical and driving history, a physical assessment to determine any physical limitations which may impact driving, a visual screening and various cognitive and perceptual tests.