Virginia DMV sends this nine-page report to a driver when Medical Review Services needs medical information, after a crash report, a medical review request, a court document, a periodic review or a condition disclosed on an application. The clinician completes the condition parts that apply, from neurological to psychiatric, plus Part F with an overall assessment of driving safety.
The driver completes the Customer Information and Information Release Approval sections; a physician, physician assistant or nurse practitioner completes Part F and whichever of Parts A to E fit the condition.
Download the current version from the source each time; forms change without notice.
Customer Medical 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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Part F, General Recommendations, every time, plus the parts matching the condition: A for neurological or musculoskeletal, B metabolic, C cardiovascular, D pulmonary and E psychiatric or substance abuse. The DMV letter that comes with the form explains the issue of concern.
The driver. The form states that any charges related to or incurred as part of completing it are the customer's responsibility. The driver also signs a release authorizing the named provider to complete the report and answer DMV's follow-up questions.
Yes. The medical provider instructions allow a letter, note or copies of records in place of the form, as long as they address all the information MED 2 requests, including your determination of the patient's ability and safety to drive.