Texas adds a communication impediment notation to a vehicle registration record so a peace officer running the plate knows the driver or a passenger may have a health condition or disability that may impede effective communication. A licensed health care professional certifies the condition on this one-page TxDMV form, and the vehicle owner authorizes the notation. No diagnosis is written on the form.
The applicant enters the vehicle identification number, plate, year and make, plus their own details, and signs. A licensed physician completes the Health Care Provider Certification for a physical condition; a licensed physician, licensed psychologist or non-physician mental health professional may complete it for a mental health condition.
Download the current version from the source each time; forms change without notice.
Certification of a Communication Impediment
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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For a physical health condition, a licensed physician. For a mental health condition, a licensed physician, a licensed psychologist or a non-physician mental health professional as defined in Section 571.003 of the Health and Safety Code. The certifier prints their name and professional license number, then signs and dates.
No. The provider certifies only that the applicant has a health condition or disability that may impede effective communication with a peace officer. The applicant authorizes a notation on the vehicle record for law enforcement use only, and TxDMV shreds the certification after processing.