DC DMV Medical/Eye Report Online Submission Form

Step 1 of 2: Submit

This form may be used to submit a DC DMV Medical/Eye Report Form online. The Medical/Eye Report Form should be completed by a licensed Medical Practitioner who can then upload it using this online submission form. Please complete all required fields.

Applicant Last Name Applicant First Name Applicant Date of Birth

DC Driver's License Number Customer Email Address Upload Completed DC DMV Medical/Eye Report Form

Medical Practitioner Name Medical Practitioner Identification Number Medical Practitioner State Medical Practitioner Email Address Medical Practitioner Telephone Number I certify that the Medical/Eye Report Form has been completed by a licensed Medical Practitioner.