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NL MRD Vision Referral Form: Driver Eye Exam

Newfoundland and Labrador's Motor Registration Division uses this one-page form when a driver is referred for an eye examination. The ophthalmologist or optometrist records Snellen acuity with and without correction, horizontal visual fields for each eye, binocular vision and the cause of any deficiency. The examiner also recommends whether the driver should wear corrective lenses or avoid driving after dusk.

Who completes it

An ophthalmologist or optometrist completes the acuity, visual field and binocular vision sections and signs with name, address and examination date; the driver enters name and licence number and signs to authorize release.

Submitting and payment

How to submit it
The form 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 say the driver may be responsible for any costs.

Good to know

  • A copy of the visual field test is required when there is a visual field anomaly or a refraction above 10 dioptres.
  • When refraction is over 10 dioptres, the visual field must be measured with the lenses worn for driving, and the form asks whether that was done.
  • The examiner classes the main cause of any visual deficiency as congenital, hereditary or acquired, and reports any binocular vision deficiency.
  • Acuity is recorded in metric Snellen notation (6/) for each eye and both eyes, uncorrected, with glasses or contacts, and with the latest correction.

Get the official form

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

Vision Referral Form

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 an optometrist complete the NL Vision Referral Form?

Yes. The form states it is to be completed by an ophthalmologist or an optometrist. The examiner records Snellen acuity for each eye and both eyes, the type of correction used (glasses, contact lenses or intraocular lenses), horizontal visual fields and binocular vision, then signs and dates it.

When must visual field testing be attached?

A copy of the visual field testing is required when the patient has a visual field anomaly or a refraction above 10 dioptres. For refraction over 10 dioptres, the field must be taken with the lenses worn for driving, and the examiner records the horizontal field in degrees for each eye.

What vision standard does Newfoundland and Labrador use for a Class 5 licence?

MRD's routine medical letter lists acuity of 20/50 (6/15) or better and a horizontal field of at least 120 degrees, both eyes open and examined together. Taxi and ride-share drivers need 20/40, and Classes 1 to 3 and emergency vehicles need 20/30 with a 150-degree field.