District of Columbia Department of Motor Vehicles - Medical Referral Form

Step 1 of 2: Submit

The Medical Referral process is a program where members of Law Enforcement, Medical Professionals, Motor Vehicle Administrations, and Concerned Relatives can report drivers whom they feel are no longer able to safely operate a motor vehicle due to a medical condition.

Only complete this form if you are a driver who is self-reporting or a member of Law Enforcement, Medical Professional, Motor Vehicle Administration, or Concerned Relative. Please note, age is not a consideration.

Upon review, DC DMV will investigate and take action as necessary. Identities of persons submitting Medical Referral reports will remain confidential.

Driver Information

Gender 

Requestor Information (Person Completing Request)

Description of Driver's Condition

Attachments

“I certify under penalty of perjury that the information contained in the Medical Referral Form is true and correct."