The DMV Vision Form is a crucial document used by the California Department of Motor Vehicles to assess an individual's vision capabilities for safe driving. It requires information from both the applicant and a vision specialist, ensuring that all necessary details are provided for evaluation. To ensure a smooth process, fill out the form accurately and bring it to your DMV appointment.
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The DMV Vision Form is a crucial document for individuals seeking to obtain or renew their driver’s license in California. This form plays a significant role in ensuring that drivers meet the necessary vision standards required for safe vehicle operation. The applicant is responsible for completing the first section, which includes essential personal information such as their driver license number, date of birth, and contact details. It is vital for applicants to sign and date the authorization line, allowing the vision specialist to share pertinent information with the Department of Motor Vehicles (DMV). The form emphasizes the importance of confidentiality, as all medical information is protected under California Vehicle Code §1808.5. After filling out the necessary sections, applicants must present the completed form along with any new corrective lenses during their visit to the DMV for further testing. Incomplete forms may be returned for additional information, and alterations could render the form invalid. The vision specialist also plays a key role by completing the second section of the form, which includes details from a vision examination conducted within the last six months. This section assesses various aspects of visual acuity, including the use of corrective lenses and recommendations for night driving. Ultimately, the DMV will evaluate the information provided to determine the applicant's ability to drive safely.
STATE OF CALIFORNIA
DEPARTMENT OF MOTOR VEHICLES®
A Public Service Agency
962
REPORT OF VISION EXAMINATION
SECTION 1 — APPLICANT COMPLETES THIS SECTION
INSTRUCTIONS: Please complete the driver license number, date of birth, telephone number, name, and address areas of this form. You must sign and date the authorization line. All medical information received by the Department of Motor Vehicles (DMV) is conidential under
California Vehicle Code (CVC) §1808.5. Please bring this completed form and any new corrective lenses with you when you return to DMV for further testing. If any section of this form is incomplete, it may have to be returned to the vision specialist for completion. DO NOT MAIL THIS FORM BACK TO DMV unless asked to do so by a DMV employee. Alterations or erased information may void this form.
Your vision specialist should conduct a new vision examination unless one has been conducted within the last six months. DMV will make the inal licensing decision based on a combination of factors, including information from your vision specialist.
DRIVER LICENSE NUMBER
NAME (FIRST, MIDDLE, LAST)
DATE OF BIRTH (MO., DAY, YR.)
HOME TELEPHONE NUMBER
()
RESIDENCE ADDRESS
CITY
STATE
ZIP CODE
I authorize the vision specialist conducting this examination to provide the Department of Motor Vehicles with the following
information for its conidential use (CVC §1808.5) in evaluating my ability to safely operate a motor vehicle.
APPLICANT’S SIGNATURE
DATE
•
20/40 with both eyes tested together, and
DMV’s Visual Acuity Screening Standard is
20/40 in one eye, and
• 20/70, at least, in the other eye.
SECTION 2 — OPHTHALMOLOGIST OR OPTOMETRIST COMPLETES THOSE SECTIONS THAT APPLY — Information must be from exam within last 6 months.
1. REFRACTION — Complete only those sections that apply.
HAVE NEW DISTANCE LENSES BEEN PRESCRIBED AND FITTED?
Yes
No If yes:
Glasses
Contact Lenses
DATE NEW LENSES WERE PRESCRIBED
IS NIGHT DRIVING RECOMMENDED?
Yes No
IS MONOVISION EMPLOYED?
DID YOUR PATIENT RECEIVE BIOPTIC LENS TRAINING?
By contact lenses
No
Not Known
By refractive surgery
DID PATIENT RECEIVE BIOPTIC LENS TRAINING THAT INCLUDED DRIVING?
Is best corrected visual acuity in each eye recommended for driving?
Bioptic Telescope
Right eye 20/ ___________
Left eye 20/___________
SKILL IN USING BIOPTIC TELESCOPE
Bioptic Telescope suitable for driving?
Satisfactory
Unsatisfactory
2. VISUAL ACUITY — Complete Clinical Measurement Section. Lenses include contact lenses or glasses.
DMV MEASUREMENT (FOR DMV USE ONLY)
CLINICAL MEASUREMENT (WITHOUT BIOPTIC TELESCOPE)
Both Eyes
Right Eye
Left Eye
Without Lenses
20/
With Current Lenses
With Lenses
Best Corrected Visual Acuity
3.DIAGNOSIS — Please indicate vision condition by checking the box(es) representing affected eye(s). If the diagnosed condition is not listed, write the diagnosis under “other diagnosis/comments” below.
REFRACTIVE R L DEVELOPMENTAL
Astigmatism
Amblyopia
Hyperopia
Strabismus
Myopia
Congenital Nystagmus
Albinism
R L OPTICAL
R L RETINAL/OPTIC NERVE R L
Cataract
Diabetic Retinopathy
Corneal Opacity
Macular Degeneration
Diplopia (uncorrectable)
Glaucoma
Keratoconus
Retinal Detachment
Aphakia
Retinitis Pigmentosa
Pseudophakia
Retinal Damage
Post. Caps. Opac.
(CRVO, PRP etc.)
VISUAL FIELDS
R L
Decreased Peripheral Vision
Hemianopia
Quadrantanopia
Decreased Peripheral Vision. Please identify the areasaffectedonthechartinSection5(seereverse)
Other diagnosis/comments
Monocular Vision (No Light Perception or Prosthesis)
If monocular, when was the monocular vision diagnosed?
If monocular, does the patient have a medical condition that could affect the functional eye in the future?
Any eye surgery (including refractive)?
Date of most recent surgery
Type of surgery
DL 62 (REV. 4/2016) WWW
*DL62*
Name:
DL/ID/X #:
4. PROGNOSIS
Diagnosis
Static
Progressive
Stable since
(date)
WHEN SHOULD DMV REQUIRE A NEW DMV VISION EXAMINATION REPORT FORM BE SUBMITTED?
Not applicable 1 year 2 years 5 years Other
5.VISUAL FIELDS — If vision is not correctable to 20/40 in each eye, or there is possible visual ield loss, a full visual ield examination (con- frontation is permissible) must be performed. Show the approximate peripheral extent and any scotomas in the diagram below.
LEFT EYE
RIGHT EYE
Extent:
Left
Right
Up
Down
6.VISUAL ABNORMALITIES — The following information will help our examiners evaluate your patient’s ability to safely operate a motor vehicle. Based upon your testing, clinical impression, or knowledge of the disorder, please indicate the severity of any of the following visual abnormalities which your patient may be experiencing. Indicate severity of condition by placing a 1 (mild), 2 (moderate), or 3 (severe) in the box(es) below.
Decreased Acuity
Color Defect
Visual Field Loss
Reduced Depth Perception
Contrast Sensitivity Loss Abnormal Eye Movements
Problems With Glare
Poor Night Vision
7. ADVICE — Have you given your patient any advice about driving?
If yes, please explain in #8 below.
8.ADDITIONAL COMMENTS — Report any additional information or comments you feel DMV should know concerning your patient’s visual and perceptual capabilities relating to driving performance. You may use an additional sheet of paper to provide this information as well as
information about any existing conditions which contribute to poor night vision or poor depth perception, etc. Any recommendations about the patient’s general safety should also be made. DMV will make the inal licensing decision based on a combination of factors, including your professional expertise.
9. SIGNATURE — This section must be completed to validate this report.
PRINTED NAME
M.D. OR O.D. LICENSE NUMBER
SIGNATURE
DATE OF EXAM (MUST BE WITHIN LAST 6 MONTHS)
X
ADDRESS
CA
TELEPHONE NUMBER
(
)
Completing the DMV Vision form is an essential step in ensuring your ability to drive safely. After filling out this form, you will need to bring it along with any new corrective lenses to your local DMV for further testing. It's important to remember that this form must be completed accurately to avoid any delays in processing.
What is the DMV Vision Form?
The DMV Vision Form is a document used in California to report a vision examination for individuals applying for or renewing a driver’s license. It helps ensure that drivers meet the necessary visual standards to operate a vehicle safely. The form must be completed by a licensed vision specialist, such as an optometrist or ophthalmologist, and submitted to the DMV.
Who needs to complete the DMV Vision Form?
Individuals who are required to provide proof of their vision capabilities must complete the DMV Vision Form. This typically applies to those who have vision impairments, are applying for a license for the first time, or are renewing their license after a certain age. Additionally, if a vision specialist recommends further evaluation, the form must be submitted.
How do I fill out the DMV Vision Form?
The form consists of two main sections. The first section requires the applicant to provide personal information, including their driver license number, date of birth, and contact information. The applicant must also sign the authorization line. The second section is to be completed by the vision specialist, who will provide details about the vision examination, including visual acuity measurements and any recommendations regarding driving.
What happens if the form is incomplete?
If any section of the DMV Vision Form is incomplete, it may be returned to the vision specialist for completion. It is crucial to ensure all required information is filled out accurately to avoid delays in processing your application or renewal.
Can I mail the DMV Vision Form to the DMV?
No, the DMV Vision Form should not be mailed back to the DMV unless specifically requested by a DMV employee. Instead, the applicant must bring the completed form along with any new corrective lenses when returning to the DMV for further testing.
What should I do if I have new corrective lenses?
If you have been prescribed new corrective lenses, you must bring them with you when you return to the DMV. The vision specialist will need to complete the form based on your current vision status with the new lenses. This is important for ensuring that your visual acuity meets DMV standards.
How often do I need to submit a new DMV Vision Form?
The frequency of submitting a new DMV Vision Form can vary. Generally, if your vision has changed or if the vision specialist indicates that a new examination is needed, you may be required to submit a new form. The DMV may also specify a time frame, such as every one to five years, depending on individual circumstances.
What if my vision is not correctable to the required standards?
If your vision is not correctable to 20/40 in each eye, or if there are concerns about visual field loss, a full visual field examination must be performed. The vision specialist will provide detailed information regarding your visual capabilities, which the DMV will consider when making a licensing decision.
When filling out the DMV Vision form, individuals often make several common mistakes that can delay the processing of their application. One frequent error is failing to provide complete personal information. The form requires the driver license number, date of birth, telephone number, name, and address. Omitting any of these details can lead to complications, as the DMV may return the form for completion.
Another mistake is not signing and dating the authorization line. The signature is essential for validating the information provided. Without it, the DMV cannot process the form, resulting in unnecessary delays. It is crucial to ensure that this step is not overlooked.
Many applicants also neglect to bring new corrective lenses when returning to the DMV. The instructions clearly state that individuals should bring any new lenses. Failing to do so may require additional visits and further testing, which can prolong the licensing process.
Inaccurate information regarding the vision examination is another common issue. The vision specialist must complete specific sections of the form based on an exam conducted within the last six months. If the information is outdated or incorrect, it can lead to complications in the evaluation of the applicant's ability to drive safely.
Some individuals mistakenly alter or erase information on the form. Such changes can void the document, forcing the applicant to start over. It is advisable to fill out the form carefully and avoid any modifications once it has been completed.
Additionally, applicants often forget to check the box for whether night driving is recommended. This information is vital for assessing the individual’s ability to drive safely under various conditions. Not addressing this question can lead to misunderstandings regarding the applicant's driving capabilities.
Another mistake is failing to provide detailed comments in the "Additional Comments" section. This area is an opportunity to communicate any relevant information about the applicant's visual and perceptual capabilities. Leaving it blank may result in the DMV missing important insights that could impact the licensing decision.
Lastly, individuals sometimes overlook the requirement for a new vision examination if their last exam was more than six months ago. If this requirement is not met, the DMV may request additional documentation, which can further delay the application process. Staying aware of these details is essential for a smooth experience with the DMV.
The DMV Vision form is an essential document for individuals seeking to ensure they meet the vision requirements necessary for operating a vehicle safely. However, there are several other forms and documents that may be required or helpful in conjunction with the DMV Vision form. Understanding these documents can streamline the process and help ensure compliance with all necessary regulations.
Having these documents prepared can facilitate a smoother interaction with the DMV. It is important to ensure that all forms are completed accurately and submitted in a timely manner. This proactive approach can help maintain compliance with driving regulations and promote safety on the roads.
When filling out the DMV Vision form, it is crucial to ensure accuracy and completeness. Here are some important do's and don'ts to consider:
Following these guidelines can help streamline the process and avoid unnecessary delays in obtaining your driver’s license.
Misconceptions about the DMV Vision form can lead to confusion and potential delays in the licensing process. Here are eight common misunderstandings:
When filling out and using the DMV Vision form, there are several important points to keep in mind. Understanding these can help ensure a smoother process and better outcomes.
By following these guidelines, you can help facilitate a more efficient process at the DMV regarding your vision examination and licensing. Remember, clarity and completeness are key to avoiding delays.