Edit, Download, and Sign the Virginia DMV Medical Review Request Form
Form
eSign
Add Annotation
Share Form
How do I fill this out?
To fill out this form, start by entering the driver's personal information. Ensure all fields are completed for accurate processing. Finally, submit the form as directed to the DMV's Medical Review Services.

How to fill out the Virginia DMV Medical Review Request Form?
1
Print or type all required information clearly.
2
Complete all sections of the form including driver and requester details.
3
Describe circumstances leading to the request.
4
Sign and date the form.
5
Mail or fax the completed form to the specified DMV address.
Who needs the Virginia DMV Medical Review Request Form?
1
Law enforcement agencies may need this form to ensure public safety regarding a driver's fitness.
2
Family members who believe a relative is unfit to drive should submit this request.
3
Health professionals may need this to refer a patient for a driving evaluation.
4
Occupational Therapists often fill this out for clients needing adaptive driving assessments.
5
Employers may require this for employees whose driving is essential for their job.
How PrintFriendly Works
At PrintFriendly.com, you can edit, sign, share, and download the Virginia DMV Medical Review Request Form along with hundreds of thousands of other documents. Our platform helps you seamlessly edit PDFs and other documents online. You can edit our large library of pre-existing files and upload your own documents. Managing PDFs has never been easier.

Edit your Virginia DMV Medical Review Request Form online.
You can easily edit this PDF on PrintFriendly by selecting the fields you want to change. The intuitive interface allows you to modify text, add notes, or adjust formatting. Save your changes directly and download the updated PDF.

Add your legally-binding signature.
Signing the PDF on PrintFriendly is simple and efficient. Use the signature tool to either draw or upload your signature directly onto the document. Once signed, you can download the completed form for submission.

Share your form instantly.
Sharing the PDF on PrintFriendly is quick and easy. Use the sharing options to send the link to others or share directly via email. This feature allows convenient access for anyone who needs to review the document.
How do I edit the Virginia DMV Medical Review Request Form online?
You can easily edit this PDF on PrintFriendly by selecting the fields you want to change. The intuitive interface allows you to modify text, add notes, or adjust formatting. Save your changes directly and download the updated PDF.
1
Open the PDF in PrintFriendly's editor.
2
Select the text or field you wish to edit.
3
Make the necessary changes directly in the fields.
4
Review your edits to ensure accuracy.
5
Download the edited PDF once you are completed.

What are the instructions for submitting this form?
To submit this form, print and complete all required fields. You can mail the form to the address provided in the instructions, or you may fax it to 1-804-367-1604. Contact the DMV Medical Review Services at 1-804-367-6203 for further questions regarding the submission process.
What are the important dates for this form in 2024 and 2025?
There are no specific important dates for this form in 2024 and 2025, as it can be submitted anytime based on need. However, ensure your request is timely to allow for processing. Always check with the DMV for any updates on procedures or requirements.

What is the purpose of this form?
The purpose of this form is to ensure that drivers are medically fit to operate a vehicle safely. It serves as a formal request for the DMV to evaluate a driver's physical or mental health status in relation to driving. This review helps to maintain road safety standards by identifying potential risks associated with certain medical conditions.

Tell me about this form and its components and fields line-by-line.

- 1. Driver Name: The full name of the driver being reviewed.
- 2. Birthdate: The driver's date of birth.
- 3. DMV Customer Number: The unique identifier assigned to the driver by DMV.
- 4. Residence Address: The home address of the driver.
- 5. Vehicle Plate Number: The license plate number of the vehicle the driver operates.
- 6. Requester Name: The name of the individual submitting the request.
- 7. Requester Organization: The agency or organization the requester is affiliated with.
- 8. Description of Circumstances: Details explaining why the medical review is needed.
What happens if I fail to submit this form?
If you fail to submit this form, the DMV will be unable to conduct a medical review of the driver. This could result in continued risk for unsafe driving, potentially affecting other road users. It is crucial to follow submission instructions carefully to avoid issues.
- Public Safety: Without a medical review, unfit drivers may pose a danger.
- Legal Consequences: Failure to properly submit may lead to legal actions against the driver.
- Delayed Processing: Late submissions can delay necessary evaluations.
How do I know when to use this form?

- 1. Law Enforcement Observations: If a law enforcement officer suspects a driver is unfit.
- 2. Family Concerns: When family members notice concerning behaviors.
- 3. Health Concerns: If health professionals identify risks that affect driving.
Frequently Asked Questions
How do I request a medical review of a driver?
Fill out the Medical Review Request Form completely and submit it to the DMV.
Can I edit the PDF form online?
Yes, you can easily edit the PDF using our online editor.
How do I submit the completed form?
You may submit it by mail or fax to the DMV Medical Review Services.
What if I have questions while filling out the form?
Contact the DMV Medical Review Services for assistance.
Is there a specific deadline for submitting this form?
Ensure to submit the form promptly to avoid any processing delays.
Can I save my changes to the PDF online?
You can download the edited PDF after making changes, but saving online is not available.
Are there any fees associated with the medical review process?
Check with the DMV for any applicable fees related to medical reviews.
How long does the medical review process take?
The duration can vary; contact the DMV for estimated processing times.
Can someone else submit this form on my behalf?
Yes, authorized individuals can submit the form for you.
What information is necessary in the request description?
Provide detailed observations regarding the driver’s potential impairments.
Related Documents - DMV Medical Review Form

Andhra Pradesh State Road Transport Corporation Student Bus Pass Application
The Andhra Pradesh State Road Transport Corporation (APSRTC) Student Bus Pass Application form is for students up to SSC who need to apply for a bus pass for the academic year 2024-2025. This form includes personal details, school details, route details, and requires a bonafide certificate. Completing this form allows students to travel on APSRTC buses between their residence and school at a concessional fare.

NYC Section 8 Request to Move Form
The NYC Section 8 Request to Move Form is for participants in good standing to move with continued assistance. Participants must meet specific criteria and obtain necessary approvals. The form includes options for non-emergency and emergency moves.

Cheyenne Transit ADA Paratransit Eligibility Application
This file includes the application and instructions for Cheyenne Transit's ADA Paratransit service. It details the eligibility criteria and provides guidelines on how to complete the form. The document must be filled out in full and submitted to determine eligibility for Paratransit service.

Council-Manager Government Roles and Responsibilities Guide
This file provides detailed information about the roles and responsibilities of key officials in a council-manager government structure, including the mayor, city manager, and elected officials. It also explains how residents can participate in the government decision-making process.

Passenger and School Bus Driver Application
This file provides detailed instructions and forms required for obtaining a Commercial Driver License (CDL) with a passenger or passenger/school bus endorsement in New Jersey. It includes fingerprinting information, medical examiner certificate requirements, and a declaration form. Applicants must complete the form, print, and sign it before visiting an Agency or the New Jersey Motor Vehicle Commission.

Facility Clearance (FCL) Orientation Handbook - March 2021
This handbook provides a comprehensive orientation to the Facility Clearance (FCL) process. It outlines responsibilities, deadlines, and guidance. It includes detailed process information and required forms.

Service Member's Individual Transition Plan Checklist
This file is a checklist intended for service members to document and certify the achievement of career readiness standards as they transition out of the military. It includes sections for personal and family needs assessment, evaluation of military service benefits and acquired skills, career readiness standards, and contact information for supporting agencies. The checklist must be completed and verified by the service member, transition counselor, and unit commander prior to separation.

Bangladesh Judicial Service Commission Form Instructions
This document provides detailed instructions for filling out and submitting the Bangladesh Judicial Service Commission form, including essential deadlines and required fields.

NORKA, RØD S - Government of Kerala Undertaking File
This document is issued by the Government of Kerala and pertains to various government-related undertakings. It provides important instructions and details necessary for various procedures. Users should follow the guidelines carefully to ensure compliance.

GOVERNMENT OF PUNJAB DEPARTMENT OF PERSONNEL MANUAL 2019
This document is a manual by the Government of Punjab's Department of Personnel, outlining various personnel policies and instructions issued in the year 2019. It includes amendments, performance indicators, appointment procedures, and relevant rules for civil services and recruitment. The manual serves as a comprehensive guide for personnel management and related administrative processes.

Oklahoma DOT Roadway Design CADD Standards Manual
The Oklahoma DOT Roadway Design CADD Standards Manual effective April 1, 2015 details the best practices for all related engineering work. Following these standards ensures readability, uniformity, and proficiency in design plans. This manual is essential for designers working with or for the Oklahoma Department of Transportation.

Affordable Connectivity Program Application Form FCC Form 5645
FCC Form 5645 is an application form for the Affordable Connectivity Program (ACP) that provides monthly internet service discounts and a one-time device benefit for qualifying low-income consumers. The form includes sections for personal information, identity verification, and household details. Instructions for submission and required documentation are also provided.