Peace Officer Vision Verification Form for Surgery - California ... - cdcr ca 2026

1. Click ‘Get Form’ to open the Peace Officer Vision Verification Form in the editor.
2. Begin by entering your personal information in the designated fields, including your name, address, and Social Security Number (SSN). Ensure accuracy as this information is crucial for processing.
3. Select your classification by circling one of the options provided (CO, YCO, YCC, MTA, or OTHER). This helps categorize your application correctly.
4. In the 'Authorization to Release Information' section, read carefully and provide your signature and date. This authorizes medical professionals to share your vision records with CDCR.
5. If you are an optometrist or ophthalmologist filling out the form, complete the visual acuity assessment sections accurately. Indicate both uncorrected and corrected vision levels as required.
6. Finally, ensure that all sections are filled out completely before saving and sending the form. Use our platform’s features to easily export or share the completed document with CDCR.

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