Form DS 699 at a glance
What it is: Request for Driver Reexamination, form DS 699 (REV. 10/2024).
Where and when to file: You may submit this form by email: DMVLADDSOffice@dmv.ca.gov.
A filled-in Form DS 699 example: a neighbor reports a driver
How to fill out Form DS 699, box by box
Person being reported
Enter the name of the person being reported (first, M.I., last) and the date of birth or approximate age; all fields marked with an asterisk (*) are required.
Enter the telephone number.
Enter the driver license number and the vehicle license plate number, if available.
Enter the street address, city, state and ZIP code.
Driver condition
Check all appropriate boxes. Provide specific details, if known, about the driver's medical (physical or mental) condition such as name of disease or illness, any medications taken, etc.
The condition boxes are Medical Condition, Confused/Disoriented, Physical Condition, Alcohol/Drug Use (Describe), Mental/Emotional Condition, Blackouts, Seizures, Fainting Spells, Vision Condition, Needs help with daily activities (i.e., cooking, dressing, bathing, balancing checkbook), Weakness or Coordination Problems, Difficulty Walking and Other.
Driver behavior
Check appropriate boxes for driving problems you have observed. Use the space if needed for additional comments.
Does not see or react to other cars, pedestrians, etc.; Turns in front of on-coming cars; Drives in wrong lane. Allows car to drift in and out of lane; Drives on wrong side of the road; Backs up or changes lanes without looking back or checking mirrors; Acts violent or aggressive when driving. Drives too slow, or stops, for no reason; Applies brake and gas pedals at the same time; Has trouble steering, braking, or otherwise controlling car. Slow reactions that may be caused by medications or drugs; Drives on sidewalk. Gets lost or confused while driving near home; Is confused by traffic.
Makes driving mistakes while talking to passengers; Falls asleep while driving; Makes turns from wrong lane; Fails to react to traffic signals, other cars, pedestrians, etc.
Other actions (Describe).
Use the space to further describe the driver's condition(s) or action(s) which lead you to believe this driver should be reevaluated by DMV.
Relationship to person being reported
Relationship to person being reported: Relative, Friend, Caregiver, Vision Specialist, Court/Code or Other.
Name kept confidential
Check here if you would like to have your name kept confidential. Confidentiality will be honored to the fullest extent possible.
Your name, address and signature
Enter your name (please print) and your daytime telephone number.
Enter your mailing address (city, state, ZIP code).
Sign in Signature and enter the Date.
Unsigned reports will not be considered.
If your situation is different
You wish the DMV to reevaluate a driver
Complete this form if you wish the Department of Motor Vehicles (DMV) to reevaluate a driver's ability to drive safely. You may request that your name not be revealed to the individual being reported.
Common questions about Form DS 699
Where do I file it?
You may submit this form by email: DMVLADDSOffice@dmv.ca.gov. Mail: Northern California (North of Fresno County) Sacramento Driver Safety 4700 Broadway, 2nd Floor Sacramento, CA 95820-1501. Southern California (South of Fresno County) El Segundo Driver Safety 390 N. Pacific Coast Highway, Ste. 2075 El Segundo, CA 90245-4470.
Sources
[1] Form DS 699 (REV. 10/2024), Request for Driver Reexamination, California Department of Motor Vehicles (the Official source link on this page).
