Alberta drivers bring this two-page form to a physician or nurse practitioner when a medical report is due: at 75, 80 and every two years after 80 for class 3, 5, 6 and 7 drivers, on a set schedule for class 1, 2 and 4 commercial drivers, and when a disclosed condition is under review. The examiner screens each body system against the CCMTA medical standards printed on the back, and Alberta Transportation decides on licensing.
Any physician or nurse practitioner licensed in Canada completes Section A (medical history and physical examination) and Section B (practitioner's statement and certificate). The driver fills in the identification block and signs Section C, the operator's certificate and waiver, and Section D is for government use.
Fill in or check the driver's name, date of birth, phone, address, occupation, the class of licence required and their operator's licence number. The class matters: the vision, hearing and other standards on the back of the form differ by class, and Section A answers are judged against the class entered here. The completed form is classified Protected A.
Record visual acuity in metric Snellen (6/) for the right eye, left eye and both eyes, uncorrected and corrected. The printed standards range from 6/9 in the better eye for classes 1 to 4 (emergency) to 6/15 for classes 5, 6 and 7, and the back of the form adds visual field minimums by class. Hearing applies only to drivers wishing to operate a bus, taxi, ambulance or dangerous goods vehicle: answer whether loss exceeds 40 decibels averaged at 500, 1000 and 2000 Hz; an audiogram may be required.
Answer Yes, No or Ref for heart or circulatory disease at NYHA functional class III, uncontrolled sick sinus syndrome, aortic aneurysm over 5.5 cm and recurrent transient ischemic attacks, and record blood pressure and the approximate date of any past myocardial infarction. Keep the scale in mind: Yes means the driver does not meet the CCMTA standard and will be ineligible at the time of application, and Ref means further specialist documentation will be required.
Covers multiple syncope episodes; spontaneous seizures that are uncontrolled or controlled for less than 12 months (toxic illness now recovered is exempt), with onset, date of last seizure and frequency; uncontrolled narcolepsy; uncontrolled Meniere's disease; post-traumatic conditions or memory dysfunction and mild dementia that should require the driver to pass a road test; and moderate to severe dementia or cognitive dysfunction. The standards note that a driver with mild dementia may be able to drive a private vehicle, with annual reassessment.
Respiratory asks about level 4 impairment, with dyspnea after walking more than 100 m at own pace on level ground or at rest. Metabolic records diabetes onset, the last significant hypoglycemic episode and type of control (diet, oral medication or insulin), then insulin-related hypoglycemic attacks controlled for less than one month or with a history of alcohol abuse, other uncontrolled hypoglycemia, and uncontrolled symptomatic hypothyroidism, Cushing's disease, Addison's disease or pheochromocytoma. Psychiatric covers uncontrolled psychosis or bipolar disorder and habitual alcohol abuse or illicit drug use.
Describe any other disorder listed in the CCMTA Medical Standards that would disqualify the driver from the class requested. The standards on the back include medications that could impair driving at the prescribed dose, impaired use of the limbs or limited mobility or coordination, and a clinical diagnosis of alcoholism or drug addiction. Loss of a limb is not a contraindication for any class if a medical review and functional assessment show safe operation, with or without compensating equipment.
State whether you are the applicant's regular physician or nurse practitioner and for how long, whether you would recommend a driver's examination, and tick each licence class, from 1 (tractor/trailer) to 7 (learners), whose medical requirements the patient meets. Print your name and address, then sign and date to certify that you examined the applicant in accordance with the CCMTA Medical Standards for Drivers. Alberta lets you choose the screening tools you use.
The driver signs and dates this section, certifying that what they told you is true and authorizing release of the information, and of any additional medical information you choose to submit, for the confidential use of Alberta Transportation. Section D beside it is completed by the registry agent or motor vehicle specialist, who record the class accepted, condition codes and licence term.
Download the current version from the source each time; forms change without notice.
Medical Examination for Motor Vehicle Operators
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.
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.
Sources for this guide
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Class 3, 5, 6 and 7 drivers need a medical report at 75, at 80 and every two years after 80. Commercial class 1, 2 and 4 drivers need one when applying, then every five years until 45, every three years from 45 to 65 and annually after 65. Alberta can also ask for one after a driver discloses a medical condition.
Any physician or nurse practitioner licensed in Canada can fill out and sign it, and Alberta leaves the choice of screening tools to the practitioner. If you answer Ref to any item, the driver will also be required to provide documentation from a medical specialist, optometrist or audiologist.
Six months from the date it is completed. Because drivers can apply for their licence up to six months before renewal, they have almost a year to complete the exam before the licence expires. Alberta Transportation reviews the report against the CCMTA medical standards for the class requested.
No. Driver medical exams are uninsured, so physicians set their own rates and must tell patients the cost before the exam starts. Alberta encourages physicians to follow the previous AHCIP rate, and CPSA standards say charges should reasonably reflect professional and administrative costs and the patient's ability to pay.