Vermont DMV requires this examination when it needs an eye doctor's opinion on whether a person's eyesight allows them to get or keep a license. A Vermont-licensed optometrist or ophthalmologist answers every question on ocular coordination, peripheral fields, red, green and yellow color perception and acuity. The examiner then states whether vision is sufficient with lenses, without lenses, or not sufficient to drive.
The applicant's name, addresses, license number and birth details go at the top. A Vermont-licensed optometrist or ophthalmologist completes all examination questions and the summary, and signs with license number and date examined.
Download the current version from the source each time; forms change without notice.
Driver Eyesight Evaluation
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 form is void if Vermont DMV receives it more than six months after the date the optometrist or ophthalmologist examined the person. The examiner records the date examined next to the signature, so the completed form should be returned promptly after the visit.
The form calls for an examination by a Vermont licensed optometrist or ophthalmologist, who records their license number and state of license. The examiner gives a decision, with due regard for public safety, on whether the applicant's eyesight is sufficient with or without lenses to operate a motor vehicle.