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The DMV Vision form plays a crucial role in ensuring that drivers meet the necessary visual standards for safe operation of a vehicle. This form is divided into two main sections: one for the applicant and another for the vision specialist, typically an ophthalmologist or optometrist. The applicant must provide personal information, including their driver license number, date of birth, and contact details. Importantly, the applicant must also sign the form, authorizing the vision specialist to share relevant information with the DMV, which is treated confidentially under California law. The vision specialist's section requires detailed clinical measurements, including visual acuity assessments with and without corrective lenses, and may involve specific tests for conditions like night vision and visual field loss. The form also addresses the necessity of new corrective lenses, if applicable, and outlines the frequency of required vision examinations. If the vision specialist identifies any visual abnormalities or conditions affecting the applicant’s ability to drive safely, these must be documented. Overall, the DMV Vision form is a vital tool that helps maintain road safety by ensuring that all drivers possess the visual capabilities needed for safe driving.

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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

Form Specifications

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 is confidential under California Vehicle Code (CVC) §1808.5, ensuring privacy for the applicant.
Submission Guidelines This form should not be mailed back to the DMV unless specifically requested. 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 one eye and 20/70 in the other eye for safe driving.

Dmv Vision: Usage Guidelines

Filling out the DMV Vision form is an important step in ensuring that you meet the necessary vision requirements for driving. After completing the form, you will need to bring it along with any new corrective lenses to your DMV appointment for further testing.

  1. Provide your driver license number: Write your driver license number in the designated area.
  2. Fill in your personal information: Include your full name (first, middle, last), date of birth (month, day, year), home telephone number, and residence address (city, state, zip code).
  3. Sign and date the authorization line: Make sure to sign and date the form to authorize the vision specialist to share your information with the DMV.
  4. Complete the vision specialist section: If applicable, the vision specialist will fill out the sections regarding new distance lenses, night driving recommendations, and visual acuity measurements.
  5. Provide any additional comments: The vision specialist may add any relevant comments regarding your visual and perceptual capabilities that could impact your driving.
  6. Ensure the form is complete: Double-check that all sections are filled out correctly. Incomplete forms may be returned for additional information.
  7. Bring the completed form to your DMV appointment: Take the form and any new corrective lenses with you when you go to the DMV.

Your Questions, Answered

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 to assess an individual's visual ability to safely operate a motor vehicle. This form must be completed by a licensed vision specialist, such as an optometrist or ophthalmologist, after conducting a vision examination. It ensures that drivers meet the necessary visual standards for safety on the road. Completing this form is crucial for maintaining public safety and ensuring that all drivers are fit to drive.

Who needs to complete the DMV Vision Form?

Individuals who are applying for a new driver's license, renewing their existing license, or have been instructed by the DMV to provide a vision examination report must complete the DMV Vision Form. This requirement may also apply to those who have experienced changes in their vision or have certain medical conditions affecting their eyesight. It is essential for anyone in these categories to have their vision evaluated and documented by a qualified specialist.

What information is required on the DMV Vision Form?

The form requires specific personal information from the applicant, including their driver license number, date of birth, name, address, and telephone number. Additionally, the vision specialist must provide details about the applicant's visual acuity, any prescribed corrective lenses, and the results of the vision examination. It is vital that all sections are completed accurately, as incomplete forms may delay the licensing process.

How should I submit the DMV Vision Form?

What happens if my vision does not meet the required standards?

If your vision does not meet the DMV's standards, you may be required to undergo additional testing or obtain corrective lenses before being allowed to drive. The DMV will evaluate the information provided by your vision specialist, along with other factors, to make a final decision regarding your driving eligibility. It is essential to follow any recommendations from your vision specialist to improve your chances of meeting the necessary requirements.

How often do I need to have my vision examined for the DMV?

The DMV typically requires a new vision examination report every one to five years, depending on your specific circumstances and any previous recommendations made by your vision specialist. If you have had a recent vision exam within the last six months, you may not need to submit a new form. However, if there are changes in your vision or if you are advised by the DMV, you should seek a new examination as necessary.

Common mistakes

  1. Incomplete Personal Information: Applicants often forget to fill in their driver license number, date of birth, telephone number, name, or address. Each of these fields is essential for processing the form.

  2. Missing Signature: Failing to sign and date the authorization line can lead to delays. Without a signature, the form may be considered invalid.

  3. Not Bringing Corrective Lenses: Some individuals neglect to bring their new corrective lenses when returning to the DMV. This is a requirement and can hinder the testing process.

  4. Incorrect Vision Examination Date: The vision examination must be conducted within the last six months. If the date is older, the DMV may require a new exam.

  5. Altering the Form: Making any alterations or erasing information can void the form. It is crucial to fill it out accurately the first time.

  6. Not Following Instructions: Some applicants do not carefully read the instructions provided. This oversight can lead to incomplete sections, resulting in the form being returned for corrections.

  7. Failing to Report All Conditions: Applicants sometimes do not disclose all relevant visual conditions or surgeries. Full disclosure is important for the DMV to make an informed decision regarding driving capabilities.

Documents used along the form

When applying for a driver’s license or renewing it, several forms and documents may be required alongside the DMV Vision form. Each of these documents serves a unique purpose in ensuring that applicants meet the necessary requirements for safe driving. Below is a list of commonly used forms and documents that accompany the DMV Vision form.

  • Driver License Application (DL 44): This form is essential for anyone applying for a new driver’s license or renewing an existing one. It collects personal information, including the applicant's name, address, and date of birth, and it must be signed by the applicant.
  • Medical Examination Report (DL 51): This document is required for applicants with certain medical conditions that could affect their ability to drive. It must be completed by a qualified medical professional and provides information on the applicant's health status.
  • Vision Examination Report (DL 62): While the DMV Vision form is specific to vision screening, this report provides a comprehensive overview of the applicant's visual capabilities. It is often filled out by an eye care professional during a vision examination.
  • Proof of Identity and Residency: Applicants must provide documents that verify their identity and residence. Acceptable forms include utility bills, bank statements, or government-issued identification that displays the current address.
  • Proof of Legal Presence: This document is necessary for applicants who are not U.S. citizens. It may include a valid passport, visa, or other documentation that confirms legal residency in the United States.
  • Application Fee Payment: A fee is typically required when submitting the application for a driver’s license. Payment can be made via check, credit card, or cash, depending on the DMV office's policies.

Understanding these additional forms and documents can streamline the application process and help ensure compliance with DMV requirements. Being prepared with all necessary paperwork will facilitate a smoother experience when visiting the DMV.

Similar forms

The DMV Vision form serves a specific purpose in evaluating an individual's vision for safe driving. Several other documents share similarities with this form, particularly in their focus on health assessments and the necessity for professional evaluations. Below is a list of documents that are comparable to the DMV Vision form, highlighting their similarities:

  • Medical Examination Report: Similar to the DMV Vision form, this document requires a healthcare provider to assess a patient's overall health, ensuring they are fit to perform specific tasks, such as driving.
  • Vision Screening Form: Like the DMV Vision form, this document is used to evaluate an individual's visual acuity and may be required for school or employment purposes.
  • Driver's License Application: This application also collects personal information and may require a vision assessment, similar to the information gathered in the DMV Vision form.
  • Physical Fitness Certification: This certification, often required for commercial drivers, assesses an individual's physical ability to operate a vehicle, paralleling the vision requirements of the DMV form.
  • Optometrist's Report: This report provides detailed information about a patient's vision, including any corrective measures, much like the information gathered in the DMV Vision form.
  • Eye Examination Report: Similar to the DMV Vision form, this document outlines the results of a comprehensive eye exam, focusing on visual acuity and any diagnosed conditions.
  • Health History Questionnaire: This form collects information about a patient's medical history, akin to the DMV Vision form's focus on relevant medical conditions affecting vision.
  • Vision Therapy Progress Report: This report tracks the progress of individuals undergoing vision therapy, focusing on improvements in visual skills, much like the DMV Vision form evaluates visual capabilities for driving.
  • Disability Verification Form: Similar to the DMV Vision form, this document may require a professional's assessment of an individual's ability to drive safely, particularly for those with disabilities affecting vision.

Dos and Don'ts

When filling out the DMV Vision form, there are important dos and don'ts to keep in mind. These guidelines will help ensure that your form is completed correctly and efficiently.

  • Do provide accurate personal information, including your driver license number, date of birth, and address.
  • Do sign and date the authorization line to confirm your consent for the vision specialist to share your information with the DMV.
  • Do bring any new corrective lenses with you when returning to the DMV for further testing.
  • Do ensure that the vision examination is conducted within the last six months.
  • Don't mail the form back to the DMV unless specifically instructed by a DMV employee.
  • Don't leave any sections of the form incomplete, as this may delay the process.
  • Don't alter or erase any information on the form, as this could void it.
  • Don't forget to check that all required sections are filled out by the vision specialist.

Misconceptions

Misconceptions about the DMV Vision form can lead to confusion and delays in the licensing process. Below are eight common misconceptions clarified.

  • The DMV Vision form can be mailed in. This form should not be mailed back to the DMV unless specifically instructed by a DMV employee. It must be submitted in person.
  • Only the applicant needs to complete the form. While the applicant must fill out their personal information, a vision specialist must also complete specific sections of the form based on their examination.
  • Any vision examination is acceptable. The vision examination must be conducted within the last six months to be valid for the DMV Vision form.
  • Altering the form is permissible. Any alterations or erased information may void the form, making it essential to fill it out accurately and completely.
  • New corrective lenses are not necessary. Applicants are required to bring any new corrective lenses prescribed during the vision examination when submitting the form.
  • The DMV only considers visual acuity. The DMV makes licensing decisions based on a combination of factors, including information from the vision specialist and other assessments.
  • Night driving recommendations are optional. If night driving is not recommended, it must be indicated on the form, as this information is crucial for assessing driving safety.
  • Vision conditions listed on the form are exhaustive. If a diagnosed condition is not listed, the vision specialist should write it in the "other diagnosis/comments" section for proper documentation.

Key takeaways

Filling out the DMV Vision form is a crucial step for individuals seeking to obtain or renew their driver's license. Here are key takeaways to ensure a smooth process:

  • Complete All Sections: Ensure that you fill out your driver license number, date of birth, contact information, and address accurately. Missing information may delay your application.
  • Authorization Required: Sign and date the authorization line. This allows your vision specialist to share necessary information with the DMV.
  • Bring Corrective Lenses: If you have new glasses or contact lenses, bring them along when returning the form to the DMV for further testing.
  • Timeliness of Examination: The vision examination must have been conducted within the last six months to be valid.
  • Avoid Mailing: Do not mail the form back to the DMV unless specifically instructed by a DMV employee.
  • Incomplete Forms: If any section is incomplete, the form may be returned to the vision specialist for completion, which could delay your application.
  • Review Visual Acuity Standards: Familiarize yourself with DMV's visual acuity standards, which include requirements for both eyes tested together and individually.
  • Professional Input Matters: The DMV will base their final licensing decision on various factors, including the evaluation from your vision specialist.

By adhering to these guidelines, you can help ensure a more efficient process when dealing with the DMV Vision form.