Form DL 51 at a glance
What it is: Medical Examination Report for Commercial Driver Fitness Determination.
Who signs: Sign at DRIVER'S SIGNATURE and enter the DATE. Your medical examination report must be signed by the physician who performed the examination.
A filled-in Form DL 51 example: a driver fills out section 1

How to fill out Form DL 51, box by box
1. Driver information

1. Driver information: the driver completes this section. Print in capital letters, using black or dark blue ink.
Fill in last name, first, driver license number, address, city, state, ZIP, work telephone number and home telephone number.
Fill in social security number, license class, state of issue, birthdate, age, sex, eyes and hair.
2. Health history

2. Health history: the driver completes this section, but the medical examiner is encouraged to discuss with the driver.
For any yes answer, indicate onset date, diagnosis, treating physician's name and address, and any current limitation. List all medications (including over-the-counter medications) used regularly or recently. (Attach additional sheet, if needed).
Driver's signature and date

By signing you certify (or declare) under penalty of perjury under the laws of the State of California that it is true and correct.
I understand that inaccurate, false or missing information may invalidate the examination and my Medical Examiner's Certification.
Sign at DRIVER'S SIGNATURE and enter the DATE.
If your situation is different
You must use this medical examination report when applying for a Commercial California Driver License (CDL)
You must use this medical examination report when applying for a Commercial California Driver License (CDL). This report also meets United States Department of Transportation (DOT) requirements. A driver who does not meet DOT's medical standards may, after evaluation by the Department of Motor Vehicles (DMV), be issued a restricted license if DMV determines the driver's condition will not affect his or her ability to drive safely. • School bus drivers 65 years of age and older must submit a new medical report to DMV every year. (Vehicle Code Section 12517.2b) • The Health Questionnaire (DL 546) may also be used by drivers applying for a Non-Commercial Class A license.
Please read the Instructions to the Driver before answering
Please read the Instructions to the Driver before answering. Mark one of the driving types.
Medical examiner completes sections 3 through 8
Medical examiner completes sections 3 through 8.
Check each item in appropriate box to show Qualified or Not Qualified.
Explain any special findings or test results NOT in an acceptable tolerance range.
Driver's identity verified by Driver License No: or Other Photo ID (Specify ID used).
Sources
[1] Form DL 51, Medical Examination Report for Commercial Driver Fitness Determination, California Department of Motor Vehicles (the Official source link on this page).
