- Driver and Vehicle Licensing Agency
- Part of:
- Assessing fitness to drive: guide for medical professionals
- 11 March 2016
Medical condition notification form for medical professionals.
Ref: DOM3854 PDF, 116KB, 2 pages
This file may not be suitable for users of assistive technology. Request an accessible format.
If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email email@example.com. Please tell us what format you need. It will help us if you say what assistive technology you use.
Use the medical notification form when patients cannot or will not notify the DVLA themselves.
This form is only for patients living in England, Scotland or Wales who hold a driving licence issued by the DVLA.
The completed form should be returned to:
Medical Business Support
Fill in all parts of the form in relation to the medical condition of your patient. Parts A and B are for your patient’s and your own details, including your signed and dated declaration that all details are correct to the best of your knowledge.
Part C of the form should be completed in all fields, please, and providing as much detail as possible regarding your patient’s medical condition.
You can send clinic letters with this notification, to help provide details of your patient’s medical condition or if you think it will aid the licensing decision.
Your patient can request copies of any medical documents held at the DVLA unless you specify in writing that releasing this information could cause serious harm to your patient.
The DVLA cannot be responsible for the payment of any fee associated with notification.
Published: 11 March 2016