West Virginia drivers referred to the DMV Driver Services Division over their ability to drive safely take this report to their physician. The examining physician records how long they have treated the patient, flags diabetes, musculoskeletal, mental, cardiovascular, alcohol or drug and neurological conditions, completes the matching Part III sections, and gives an opinion on safe driving, periodic evaluations and restrictions.
The driver completes and signs Part I before the visit, authorizing release to DMV. A licensed physician completes Parts II through IV and signs.
Download the current version from the source each time; forms change without notice.
Medical Report Form
If your copy of the form is a fillable PDF, upload it 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 and their requirements change without notice, so check the official page for the current version before you complete one.
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The report must reflect the licensed physician's personal examination performed within 90 days of the report being filed with DMV. The patient signs Part I before the visit, authorizing the physician to release the report and any other medical information needed to decide fitness to drive.
Part IV asks whether the applicant can safely operate a motor vehicle, whether periodic medical evaluations are recommended and how often, and whether restrictions such as limited driving distance, daylight driving only or no interstate driving should apply. Commercial drivers use the separate DLAB-CDL-1 report.