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Virginia DMV MED 4: Customer Vision Report

Virginia drivers bring this report to an ophthalmologist or optometrist when they fail the DMV vision test, are on vision review, want their own doctor's test at renewal, or seek a CDL waiver. The eye doctor lists visual and ocular conditions, uncorrected and best corrected acuity, and temporal and nasal field measurements. DMV compares the results with Virginia's standards for full, daylight-only and commercial licenses.

Who completes it

The customer fills in Customer Information before the visit. An ophthalmologist or optometrist completes the Vision Examination section, visual measurements and certification, checking which profession applies.

Submitting and payment

How to submit it
For a renewal, the customer brings the completed form to a DMV customer service center within 90 days; for a medical review the doctor faxes it to Medical Review Services, and for a CDL waiver the doctor faxes it together with MED 30.
Who pays
Any charges for completing the form are the customer's responsibility.

Good to know

  • Record acuity at the lowest line read with 100 percent accuracy, in whole numbers only; the standards must be met without a telescopic lens.
  • Virginia's standard license requires 20/40 and 110 degrees of horizontal vision; 20/70 and 70 degrees qualifies for a license restricted to daylight hours.
  • High-risk conditions such as glaucoma, retinitis pigmentosa or optic neuropathy need threshold perimetry (HFA 30-2 or 24-2) plus testing to 120 degrees, such as HVF 60-4.
  • DMV will not accept confrontation, tangent screen or automated screening fields for high-risk patients. Glasses should not be worn during field testing; contact lenses are allowed.

Get the official form

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

Customer Vision Report

Official pagePDF

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

When is a visual field analysis required on Virginia MED 4?

If the patient has a condition that could affect the peripheral field, attach a graphic visual field analysis to 120 degrees total in each eye, preferably HVF 30-2 and 60-4. The field section may be left blank only when a graphic analysis is provided. Progressive conditions are reviewed annually, and repeat fields are requested at least every 3 years.

What are Virginia's vision standards for a CDL?

The form lists 20/40 or better in each eye and 140 degrees or better of horizontal vision. CDL or CLP holders who cannot meet Virginia's minimums may apply for an intrastate-only disability waiver if they meet federal vision rules. Color perception is required, and a graphic field to 120 degrees in each eye must be submitted.

How long is a MED 4 good for at a Virginia DMV renewal?

For a license renewal, the customer must bring the completed report to a DMV customer service center within 90 days. Reports for a medical review or a CDL waiver do not go through the customer service center; the doctor's office faxes them directly to Medical Review Services.