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Wyoming Driver Medical Evaluation (WYDOT FSDI-915)

WYDOT Driver Services requires this evaluation when a driver must have a medical evaluation for licensing. A qualified medical professional marks one opinion: not capable of safe driving, a past lapse of consciousness or motor function that no longer exists or is controlled, or capable with restrictions. The professional can also recommend a road test or an annual evaluation.

Who completes it

The applicant's name, license number, address and birth date go at the top. A qualified medical professional, defined on the form as a physician or other qualified health care professional working within scope, completes and signs the Medical Section.

Submitting and payment

How to submit it
Mail, fax or email the completed form to WYDOT Driver Services, Driver Compliance, or upload it through oneWYO; incomplete forms may be returned to the medical professional.

Good to know

  • Mark only one option. Option 1, not capable of safely operating a motor vehicle, results in cancellation or denial of the driver license.
  • If the evaluation meets an annual requirement, it must come from an examination within the last 3 months.
  • Restriction choices include automatic transmission, no interstate driving, daylight driving only, speed zone or distance limits, a prosthetic aid and special adaptive equipment.
  • The vision counterpart is the Driver Vision Evaluation (FSDI-914), completed by a qualified vision specialist.

Get the official form

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

Driver Medical Evaluation

Official pagePDF

Fill it with Vero

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.

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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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Who can complete Wyoming's Driver Medical Evaluation?

Only a qualified medical professional: a physician or other qualified health care professional who is qualified by education, training, licensure and facility privileging where applicable, and who performs the service within their scope of practice. The signer certifies they examined the applicant and gives classification, specialty and license number.

Is Wyoming's Driver Medical Evaluation confidential?

Yes. The form states the information is confidential and used only to determine eligibility and restrictions for licensing. Wyoming Statute 31-7-123 lets the department cancel or deny a license when a qualified medical professional finds a condition makes the person unable to drive safely.