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The DMV Vision Form is an essential document for individuals seeking to obtain or renew their driver’s license in California. This form is designed to assess an applicant's visual acuity and overall ability to safely operate a motor vehicle. The process begins with the applicant filling out personal information, including their driver license number, date of birth, and contact details. It is crucial for the applicant to sign and date the form, as this authorizes the vision specialist to share pertinent information with the Department of Motor Vehicles (DMV). This information is treated as confidential under California law. Following the applicant's completion, a licensed ophthalmologist or optometrist must evaluate the individual’s vision, ensuring that the examination occurs within six months of submitting the form. The vision specialist provides detailed information regarding the applicant's visual acuity, including whether corrective lenses are required and if night driving is advisable. The form also allows for the diagnosis of any visual impairments, which may affect driving capabilities. Any incomplete sections may necessitate further evaluation by the vision specialist, and alterations to the form can render it invalid. Ultimately, the DMV utilizes this comprehensive assessment to make informed decisions regarding an applicant's driving eligibility.

Dmv Vision Example

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

Yes

No

 

 

 

 

 

Yes

No

Not Known

 

By refractive surgery

Yes

No

 

 

 

 

 

 

 

 

 

 

 

DID PATIENT RECEIVE BIOPTIC LENS TRAINING THAT INCLUDED DRIVING?

Is best corrected visual acuity in each eye recommended for driving?

Yes

No

Yes

No

Not Known

 

 

 

 

 

 

 

 

 

 

 

Bioptic Telescope

Right eye 20/ ___________

Left eye 20/___________

SKILL IN USING BIOPTIC TELESCOPE

 

 

 

 

 

Bioptic Telescope suitable for driving?

Yes

No

 

 

 

Satisfactory

Unsatisfactory

Not Known

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

Both Eyes

Right Eye

Left Eye

 

 

 

 

 

 

 

 

 

Without Lenses

20/

20/

 

20/

Without Lenses

20/

20/

20/

 

 

 

 

 

 

 

 

 

With Current Lenses

20/

20/

 

20/

With Lenses

20/

20/

20/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Best Corrected Visual Acuity

20/

20/

20/

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?

Yes

No

Any eye surgery (including refractive)?

Yes

No

Date of most recent surgery

 

Type of surgery

 

 

 

 

 

 

 

 

 

 

DL 62 (REV. 4/2016) WWW

*DL62*

 

Name:

DL/ID/X #:

4. PROGNOSIS

Diagnosis

 

Static

Diagnosis

 

Static

Diagnosis

 

Static

Progressive

Stable since

 

(date)

Progressive

Stable since

 

(date)

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:

 

 

Extent:

Left

 

 

 

Left

Right

 

 

 

Right

Up

 

 

 

Up

Down

 

 

 

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.

R L

Decreased Acuity

Color Defect

R L

Visual Field Loss

Reduced Depth Perception

R L

Contrast Sensitivity Loss Abnormal Eye Movements

R L

Problems With Glare

R L

Poor Night Vision

7. ADVICE — Have you given your patient any advice about driving?

Yes

No

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

CITY

CA

ZIP CODE

TELEPHONE NUMBER

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

DL 62 (REV. 4/2016) WWW

File Breakdown

Fact Name Details
Purpose of the Form The DMV Vision Form is used to report the results of a vision examination for individuals applying for or renewing a driver's license in California.
Confidentiality All medical information provided to the DMV is confidential under California Vehicle Code (CVC) §1808.5.
Submission Guidelines This form should not be mailed to the DMV unless specifically requested by a DMV employee. It must be brought in person along with any new corrective lenses.
Vision Standards The DMV requires a minimum visual acuity of 20/40 in both eyes tested together, 20/40 in one eye, and 20/70 in the other eye.
Time Frame for Examination The vision examination must be conducted within the last six months prior to submitting the form.
Alterations Policy Any alterations or erased information on the form may void it, necessitating a new vision examination.

Guide to Using Dmv Vision

Completing the DMV Vision form is a straightforward process that requires careful attention to detail. Once the form is filled out, it should be brought to the DMV along with any new corrective lenses for further testing. Make sure all sections are complete to avoid delays in processing.

  1. Start by entering your driver license number in the designated field.
  2. Provide your name (first, middle, last) as it appears on your identification.
  3. Fill in your date of birth in the format of month, day, and year.
  4. Input your home telephone number including the area code.
  5. Complete your residence address, including city, state, and zip code.
  6. Sign and date the authorization line to allow the vision specialist to share your information with the DMV.

After completing these steps, ensure you have any new corrective lenses ready for your visit to the DMV. If any part of the form is incomplete, it may be returned for further information. Remember, this form should not be mailed unless specifically instructed by a DMV employee.

Get Answers on Dmv Vision

What is the DMV Vision Form and why is it necessary?

The DMV Vision Form is a document required by the California Department of Motor Vehicles (DMV) to assess an individual's visual acuity before they can obtain or renew a driver's license. This form ensures that drivers meet the necessary vision standards to operate a vehicle safely. It must be completed by a licensed vision specialist, such as an optometrist or ophthalmologist, and submitted to the DMV as part of the licensing process.

How do I complete the DMV Vision Form?

To fill out the DMV Vision Form, you will need to provide personal information such as your driver license number, date of birth, and contact details. You must also sign and date the authorization line. After that, a vision specialist will conduct an examination and complete the relevant sections of the form, including visual acuity measurements and any recommendations regarding corrective lenses or driving restrictions.

What happens if I submit an incomplete form?

If any section of the DMV Vision Form is incomplete, it may be returned to the vision specialist for completion. This could delay your application process, so it’s crucial to ensure that all required fields are filled out correctly. Additionally, alterations or erased information may void the form, making it necessary to start over.

How often do I need to submit the DMV Vision Form?

The DMV may require you to submit a new Vision Form at different intervals, depending on your individual circumstances. Generally, if your vision condition changes or if you have not had a vision examination in the last six months, you will need to complete a new form. The vision specialist will indicate on the form how frequently the DMV should require a new report, which could range from one year to five years or other specified timeframes.

What should I do with the completed DMV Vision Form?

After the vision specialist has completed the form, you must bring it to the DMV along with any new corrective lenses, if applicable. Do not mail the form unless instructed to do so by a DMV employee. Presenting the completed form in person ensures that all information is reviewed and processed correctly during your visit.

What if I have specific vision conditions?

If you have a specific vision condition, such as monocular vision or a diagnosed visual impairment, it’s important to discuss this with your vision specialist. They will provide detailed information on your visual capabilities and any recommendations for driving. This information is crucial for the DMV's assessment of your ability to drive safely. Your specialist may also provide additional comments that the DMV should consider when making their final licensing decision.

Common mistakes

When filling out the DMV Vision form, many people make common mistakes that can delay their application process. One frequent error is not providing complete personal information. It’s essential to fill in your driver license number, date of birth, telephone number, name, and address accurately. Missing any of these details can result in the form being returned for completion.

Another mistake is neglecting to sign and date the authorization line. Without your signature, the DMV cannot process the form. It's a simple step that can easily be overlooked but is crucial for validating your request.

Some individuals forget to bring their new corrective lenses when returning to the DMV. If you have received new glasses or contact lenses, you need to bring them along for further testing. This requirement helps ensure that your vision is assessed accurately.

People often fail to check the box indicating whether night driving is recommended. This information is important for the DMV to understand your driving capabilities, especially if you have specific vision conditions. Not providing this detail can lead to additional questions or complications.

Another common oversight is altering or erasing information on the form. Any changes can void the document, causing unnecessary delays. It’s best to fill out the form carefully and correctly the first time.

Some applicants do not ensure that their vision examination was conducted within the last six months. If the examination is outdated, the DMV may require a new evaluation, which can prolong the process.

In the visual acuity section, people sometimes forget to include their best corrected visual acuity for each eye. This information is vital for the DMV to assess your eligibility to drive safely. Double-checking this section can save time and hassle.

Additionally, individuals may overlook the section for additional comments. This space is an opportunity to provide any relevant information about your vision that the DMV should consider. Failing to utilize this section can mean missing out on important details that could aid your case.

Lastly, forgetting to have the vision specialist complete the necessary sections can lead to delays. The vision specialist’s input is crucial, and if their part is incomplete, the DMV may require additional follow-up, which can slow down the licensing process.

Documents used along the form

When completing the DMV Vision form, several other documents may also be required. These documents help ensure that your vision is properly evaluated and that you meet the necessary standards for safe driving. Below is a list of commonly used forms that accompany the DMV Vision form.

  • Driver License Application: This form is used to apply for a new driver’s license or to renew an existing one. It collects personal information, including your name, address, and date of birth.
  • Medical Report (DL 546): This report is required if you have a medical condition that may affect your ability to drive. It must be completed by a licensed healthcare provider and submitted to the DMV.
  • Vision Examination Report (DL 62): Similar to the DMV Vision form, this report is filled out by a vision specialist and provides detailed information about your visual acuity and any corrective measures taken.
  • Proof of Identity: Acceptable documents include a birth certificate, passport, or other government-issued ID. This is necessary to verify your identity when applying for or renewing your driver’s license.
  • Proof of Residency: Documents such as utility bills or bank statements can serve as proof of your current address. This is required to ensure that your license reflects your correct residence.

Gathering these documents in advance can streamline the process and help avoid delays. Make sure all information is accurate and up-to-date to facilitate a smooth experience at the DMV.

Similar forms

  • Medical Examination Report: Similar to the DMV Vision form, a medical examination report includes detailed health information about an individual. It often requires the patient to provide personal details, such as their name and date of birth, and is completed by a healthcare professional. Both documents aim to assess an individual's ability to perform specific tasks, like driving safely.

  • Vision Screening Report: This document focuses specifically on an individual's vision capabilities. Like the DMV Vision form, it assesses visual acuity and may include recommendations regarding corrective lenses. Both forms serve as tools to ensure that individuals meet the necessary vision standards for activities like driving.

  • Driver's License Application: The driver's license application requires personal information and may ask for medical history, similar to the DMV Vision form. Both documents are essential in evaluating an applicant's fitness to drive, ensuring that they meet the state's requirements.

  • Eye Examination Report: An eye examination report is completed by an optometrist or ophthalmologist and includes findings related to an individual's vision. This document, like the DMV Vision form, contains details about visual acuity and any corrective measures prescribed, providing important insights into a person's ability to drive safely.

  • Physical Examination Report for Commercial Drivers: This report is specifically tailored for those seeking a commercial driver's license. It assesses various health factors, including vision, much like the DMV Vision form. Both documents help ensure that drivers are physically capable of operating a vehicle safely.

Dos and Don'ts

Filling out the DMV Vision form can be straightforward if you keep a few important points in mind. Here are some do's and don'ts to guide you through the process:

  • Do provide accurate personal information, including your driver license number, date of birth, and contact details.
  • Do sign and date the authorization line to validate your submission.
  • Do ensure that the vision examination is conducted within the last six months for validity.
  • Do bring any new corrective lenses with you when returning to the DMV.
  • Don't mail the form back to the DMV unless specifically instructed by a DMV employee.
  • Don't alter or erase any information on the form, as this may void it.
  • Don't leave any sections incomplete; missing information could delay processing.
  • Don't forget to check if night driving is recommended by your vision specialist.

By following these guidelines, you can help ensure a smoother experience with the DMV. Take your time, double-check your entries, and don't hesitate to ask for assistance if needed.

Misconceptions

Here are five common misconceptions about the DMV Vision form:

  • It can be mailed to the DMV. Many believe they can send the completed form by mail. However, this form should not be mailed unless instructed by a DMV employee.
  • Only eye doctors can fill out the form. While the vision specialist must complete certain sections, the applicant is responsible for filling out their personal information in Section 1.
  • The form can be altered if mistakes are made. Any alterations or erased information may void the form. It is essential to fill it out correctly the first time.
  • Vision exams are only required for new drivers. Existing drivers may also need to submit a new vision examination report, especially if their vision has changed or if they have had eye surgery.
  • All vision specialists can sign the form. Only licensed ophthalmologists or optometrists can complete and sign the sections that apply to the vision examination.

Key takeaways

When filling out the DMV Vision form, it is essential to pay attention to several key aspects to ensure a smooth process. Here are some important takeaways:

  • Complete All Required Sections: Make sure to fill in your driver license number, date of birth, name, address, and telephone number. Incomplete sections may delay your application.
  • Sign and Date the Form: Your signature and the date on the authorization line are crucial. Without them, the form may not be processed.
  • Bring Corrective Lenses: If you have new corrective lenses, bring them with you when you return to the DMV for further testing. This is important for accurate evaluation.
  • Consult Your Vision Specialist: If you have not had a vision examination in the last six months, a new exam is necessary. This ensures that the information provided is current and accurate.
  • Avoid Alterations: Do not make any changes to the form. Alterations or erased information can void the document, leading to potential complications.

By keeping these points in mind, you can help facilitate a more efficient experience when submitting your DMV Vision form.