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Ontario Vision Report to the Registrar (Form 5109)

Ontario optometrists use this two-page form to report a patient's visual impairment to the Registrar of Motor Vehicles under Highway Traffic Act section 203. Section A is the mandatory report for acuity below 20/50, a visual field below the regulated thresholds, or diplopia that cannot be corrected; Section B covers discretionary reports. A mandatory report results in a licence suspension.

Who completes it

The optometrist completes all three parts: patient information, the visual impairment details in Section A or Section B, and practitioner information with licence number and signature.

Submitting and payment

How to submit it
Complete it on a computer, then print, sign and mail or fax it to MTO's Driver Medical Review Office; ontario.ca says not to photocopy the form.

Good to know

  • Mandatory field criteria: under 120 continuous degrees on the horizontal meridian, under 15 degrees above and below fixation, or under 60 degrees either side of the vertical midline, including hemianopia.
  • Diplopia is reportable when it is within 40 degrees of fixation in all directions of primary position and cannot be corrected with prism lenses or patching.
  • Fields must be measured without telescopic or prism lenses or sidebar prisms, must exclude the natural blind spot and must centre on the fixation point, per page 2.
  • Suspensions for failing mandatory vision standards cannot be appealed to the Licence Appeal Tribunal, and patients can request a copy of the report under FIPPA.

Get the official form

Download the current version from the source each time; forms change without notice.

Vision Report to the Registrar of Motor Vehicles

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Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

When must an Ontario optometrist file a mandatory vision report?

Section A applies when the patient has or appears to have best corrected acuity below 20/50 with both eyes open and examined together, a visual field below the thresholds in Regulation 340/94, or diplopia within 40 degrees of fixation that prisms or patching cannot correct. Optometrists report only visual impairments.

What is a discretionary vision report in Ontario?

Section B, under Highway Traffic Act section 203(2), lets the optometrist report a visual condition that is not on the mandatory list but may make it dangerous for the person to drive. Discretionary reports do not always result in a suspension, and MTO may request follow-up information or an assessment first.

What vision standards does Ontario apply to drivers?

Page 2 of the form quotes Regulation 340/94. Class G, G1, G2, M, M1 and M2 drivers need acuity no poorer than 20/50 and a 120-degree horizontal field. Class A to F drivers need 20/30 with both eyes, 20/100 in the weaker eye and a 150-degree field.