Physicians and other health professionals, relatives, caregivers and law enforcement use this form to ask the California DMV to reevaluate whether someone can still drive safely. The reporter checks the driver's medical, physical, mental or vision conditions and the unsafe driving behaviors observed, adds details such as the diagnosis or medications, and signs before sending it to DMV Driver Safety.
Whoever is making the report completes the whole form, including their relationship to the driver, such as relative, friend, caregiver or vision specialist. The driver being reported does not complete any part.
Download the current version from the source each time; forms change without notice.
Request for Driver Reexamination
Solicitud Para Reexaminación de Conductor
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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You can check a box asking that your name be kept confidential, and DMV says confidentiality will be honored to the fullest extent possible. You still have to sign and give your name and mailing address, because unsigned reports will not be considered.
No. DS 699 is a voluntary request that anyone can file directly with DMV Driver Safety. Physicians' mandatory reports of patients with lapses of consciousness, Alzheimer's or related disorders go to the local health officer on the Confidential Morbidity Report, CDPH 110c, who forwards them to DMV.