MED 2 at a glance
What it is: MED 2 Customer Medical Report: use this form to request medical information from your physician, physician assistant or nurse practitioner.
Who signs: Sign the CUSTOMER SIGNATURE AND AUTHORIZATION; a parent must sign for a minor.
What to bring and attach to MED 2
Provide the entire MED 2 and your DMV letter to your medical provider at the time of your medical examination.
A filled-in MED 2 example: a customer fills out page 1
How to fill out MED 2, box by box
Customer information
Enter your NAME (Last) (First) (MI) (Suffix) and your CUSTOMER NUMBER (from your driver's license) or SSN.
Enter the RESIDENCE/HOME ADDRESS with CITY, STATE, ZIP CODE and CITY OR COUNTY OF RESIDENCE.
Enter the MAILING ADDRESS with CITY, STATE and ZIP CODE.
Enter your DAYTIME TELEPHONE NUMBER, BIRTH DATE (mm/dd/yyyy), WEIGHT in lbs and HEIGHT in FT and IN.
If you enter a residence or mailing address that is other than what is currently on DMV's system, complete an "Address Change Request" (ISD 01).
Your medical condition and medications
Describe, in detail, your medical condition.
If Yes, list the prescription/non-prescription medications; attach a separate sheet if more space is required.
List each NON-PRESCRIPTION MEDICATION and PRESCRIPTION MEDICATION with its DOSAGE and TIME(S) TAKEN.
Blackout, seizure, loss of consciousness, or syncope
If Yes, enter date of last episode of a blackout, seizure, loss of consciousness, or syncope.
Did the episode result in a motor vehicle crash? (YES or NO)
Explain what happened during the episode.
Commercial driver license disability waiver or hazardous materials variance
If you are applying for a commercial driver license disability waiver or a hazardous materials variance (YES), a CDL Disability Waiver or Hazardous Materials Variance Application (MED 30) must also be submitted.
Information release approval
INFORMATION RELEASE APPROVAL.
You authorize a licensed medical provider to complete this Customer Medical Report, submit it to DMV and, if necessary to provide further clarification or information to DMV about your medical or visual impairment. Virginia Code § 46.2-208(b)(1) prohibits DMV from releasing medical data to anyone other than a physician, physician assistant or nurse practitioner.
Sign the CUSTOMER SIGNATURE AND AUTHORIZATION; a parent must sign for a minor.
Enter the DATE (mm/dd/yyyy).
More rules for MED 2
Review all correspondence received from the Department of Motor Vehicles (DMV) regarding concerns about your ability to safely operate a motor vehicle.
Complete the sections of the MED 2 titled “Customer Information” and “Information Release Approval”.
Be sure to provide your signature at the end of the “Information Release Approval” section.
Request your medical provider to complete Part F and the parts of the MED 2 that pertain to your medical condition(s) and return the report to DMV.
Suspension notices, incidents and medical providers
You received an Official Notice/Order of Suspension
If you received an Official Notice/Order of Suspension, you must provide DMV with the required Customer Medical Report (MED 2), prior to the effective date noted in the Notice/Order to avoid having your driving privilege suspended.
Provide your requested information at least 5 - 7 days before your suspension deadline to allow for processing time.
The medical examination must be conducted after the issue date of your Official Notice/Order of Suspension.
If your driving privilege is suspended, you will be required to provide proof of legal presence in order to reinstate your driver's license, if you have not already provided proof.
You were involved in a particular incident, recent motor vehicle crash or have experienced a recent blackout, seizure or loss of consciousness
If you were involved in a particular incident, recent motor vehicle crash or have experienced a recent blackout, seizure or loss of consciousness, the MED 2 report must reference these incidents and/or events.
You are the medical provider
You must complete Part F and the parts of the MED 2 that pertain to your patient's medical condition(s).
Neurological/Musculoskeletal - Part A & F
Metabolic - Part B & F
Cardiovascular - Part C & F
Pulmonary - Part D & F
Psychiatric/Substance Abuse - Part E & F. Only one Part F is required if the same medical provider completes multiple report sections.
In lieu of completing the MED 2, you may submit a letter, note or copies of records as long as the information you submit addresses all of the information requested on the MED 2 including your determination on the patient's ability and safety to drive.
Return the completed MED 2 to DMV by faxing it to DMV Medical Review Services at (804) 367-1604.
Common questions about MED 2
Are there fees?
Any charges related to or incurred as part of the completion of this form are the customer's responsibility.
Where to get help with MED 2
If you have questions related to DMV's requirement for you to submit a MED 2, you may contact DMV Medical Review Services:
Telephone - (Voice) 1-804-367-6203 or (Deaf/Hearing Impaired only) 1-800-272-9268
Sources
[1] Form MED 2 (07/01/2024), Customer Medical Report, Virginia Department of Motor Vehicles (the Official source link on this page).