Delaware's Division of Motor Vehicles uses this one-page report when a driver license applicant's vision needs an eye doctor's assessment. The optometrist or ophthalmologist records acuity with and without correction, eye disease or structural defects, field defects, whether lenses would help, recommended restrictions and how often vision should be rechecked for driving.
An optometrist or ophthalmologist completes the whole report and certifies the state where they are licensed and their license number. The applicant's name, date of birth and license number go at the top.
Download the current version from the source each time; forms change without notice.
Report of Visual Status by an Optometrist or Ophthalmologist
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.
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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The standards printed on the Report of Visual Status are 20/40 for an unrestricted license, 20/50 for daylight driving only, and license denial below 20/60. The eye doctor can also recommend a corrective lenses restriction and how often vision should be rechecked.
No. The form says to mail it to the DMV examiner and not return it to the applicant. It can also be faxed or emailed to the DMV Medical Section. Include a prescription blank or your own statement with the report.