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NL MRD Diabetic Questionnaire for Drivers

Newfoundland and Labrador's Motor Registration Division (MRD) requests this one-page questionnaire when a driver's diabetes has to be assessed for licensing. The physician answers 12 questions on treatment, hypoglycemia awareness, severe episodes, glucose monitoring and complications such as neuropathy, cardiovascular disease and retinopathy, then says whether driving should be restricted. MRD uses the answers in its medical assessment of the driver's licence.

Who completes it

The driver enters name and licence number and signs to authorize release of the information; the physician answers questions 1 to 12, and the signature block also accepts a nurse practitioner's name and address.

Submitting and payment

How to submit it
The questionnaire prints no return instructions, so send it to MRD's Medicals and Driver Records section, which lists fax, email and mailing contacts on MRD's contact page.
Who pays
The form names no fee, and MRD's related medical letters tell drivers they may be responsible for any costs.

Good to know

  • If the patient does not monitor blood sugar, question 7 asks for a glycosylated hemoglobin result from the last 3 months, with the normal values of the test used.
  • The form defines a severe hypoglycemic episode as any episode requiring outside intervention and asks for the date of the most recent one.
  • Question 3 asks whether the patient knows how to raise target glucose values during shift work, after a question on understanding insulin dose, diet and exercise.
  • MRD's routine medical letter adds that commercial drivers treated with insulin must keep a log of their blood sugars.

Get the official form

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

Diabetic Questionnaire

Official pagePDF

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

Can a nurse practitioner complete the NL Diabetic Questionnaire?

The heading addresses the driver's physician, but the signature block reads 'Physician/Nurse Practitioner', so the form is laid out for either to sign. The practitioner also gives an office telephone number and the date of examination, and the driver signs separately to certify the information and authorize its release.

What does the questionnaire ask about hypoglycemia?

It asks whether the patient gets early warning symptoms of hypoglycemia, whether they have had a severe episode needing outside help and when the last one occurred, and whether blood sugar values are satisfactory in the practitioner's opinion. Question 1 first records insulin start date, type and dosage, or the oral agents used.

Is the Diabetic Questionnaire a fillable PDF?

Yes. MRD posts it as a fillable PDF, revision 11-2021, on its Forms and Fees page, which tells users to download the form, complete it and save it. The practitioner still signs and dates the examination, and the driver signs at the bottom.