New Hampshire DSMV 61: DMV Eye Examination Form

New Hampshire DMV staff screen vision at licensing and send applicants to an ophthalmologist or optometrist when more accurate measurements are needed or an eye defect seems apparent. The eye doctor records acuity on DSMV 61 against the state minimum of 20/40 with both eyes or 20/30 with one eye and recommends whether the person is visually capable of holding a license.

Who completes it

An ophthalmologist or optometrist completes and signs Part A; an optician certifies any new corrective lenses in Part B; a medical doctor completes Part C when acuity falls below the minimum. The person examined signs a consent to release the report to the DMV.

Submitting and payment

How to submit it
The applicant returns the completed form to the New Hampshire DMV; it is valid only for 30 days after the optometrist or physician signs it.

Good to know

  • Part A records each eye and both eyes without lenses, with old lenses and with new lenses, then gives one of five recommendations, from capable without lenses to not visually capable.
  • Part C, under Saf-C 1004.08, is for applicants below the standard but within 20/40 to 20/70. The doctor must complete Section I or Section II in full, or the application is rejected.
  • Section I recommends an unrestricted license other than corrective lenses. Section II recommends a license restricted to daylight hours, half an hour before sunrise to half an hour after sunset.
  • A doctor who cannot give an unqualified certification should not sign Part C. A separate form, DSMV 125, covers eye examinations done out of state.

Get the official form

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

Eye Examination

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 and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What vision does New Hampshire require for a driver license?

DSMV 61 states that the rules require at least 20/40 with both eyes or 20/30 with vision in one eye. An applicant between 20/40 and 20/70 needs Part C, where a doctor certifies safe driving and recommends either an unrestricted license or one limited to daylight hours.

How long is the New Hampshire eye examination form valid?

Only 30 days after the optometrist or physician signs it, so the applicant should take it to the DMV promptly. If new glasses or contacts were prescribed, the optician who fitted them completes Part B with the date the lenses were fitted or installed.

What does the doctor certify in Part C of DSMV 61?

That they are familiar with the applicant's current condition and that the applicant is physically and mentally capable of driving on all public highways, either without restriction other than corrective lenses (Section I) or only in daylight with corrective lenses (Section II). The certification must be unqualified.