Alaska's Division of Motor Vehicles uses this confidential report to decide whether a driver can safely operate a motor vehicle when vision, a medical condition, a seizure or loss of consciousness, or mental health is in question. Each of its four examiner sections ends with an opinion on safe driving, which DMV relies on for licensing, restrictions or re-evaluation.
The patient signs the Part I release. Examiners complete Part II and the relevant sections: eye (physician or optometrist), medical (physician or neurologist), loss of consciousness or seizure, and mental (physician, psychiatrist or psychologist), each with its own signature block.
Download the current version from the source each time; forms change without notice.
Confidential Eye/Medical/Mental 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.
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Yes. Each section is written for a particular examiner: the eye section for a physician or optometrist, the medical section for a physician or neurologist, and the mental section for a physician, psychiatrist or psychologist. Each section has its own name, title, signature and evaluation date fields.
The patient. In the Part I release, the patient authorizes the physician or hospital to answer DMV's questions and agrees that any expense involved is charged to them and not to the State of Alaska. DMV does not pay examiners for the report.