Colorado's DMV uses this eye report to decide whether a driver's vision supports licensing, with or without restrictions. The examiner records progressive eye conditions, visual field deficits, distance acuity with and without correction and through bioptic lenses, and horizontal fields, then picks one fitness-to-drive finding and any license restrictions.
The driver completes the Driver/Patient Section. The examiner section must be completed and signed by an MD or DO, PA, APRN, or an ophthalmologist or optometrist, who must also give specialty, license number and phone.
Download the current version from the source each time; forms change without notice.
Confidential Eye Examination Report
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
The form is valid for 180 days from the date of the examination. When the DMV has requested the report after a notice of cancellation and denial, the examination date also has to fall after the issue date of that notice.
A physician (MD or DO), physician assistant, advanced practice registered nurse, or an ophthalmologist or optometrist (OD). Specialty, license number and phone number are required fields, and the signature is required. Good-faith opinions are protected from civil or criminal action under C.R.S. 42-2-112.
The Driver/Patient Section includes a statement of understanding and a signature line, but the form says the driver's signature is not required for DMV processing. The driver still fills in name, address, Customer Identification Number if known, and date of birth.