Print or type all information. Complete form in its entirety.
Mail or fax: mail completed form to Medical Review Services at Post Office Box 27412, Richmond, Virginia 23269-0001, or fax to Medical Review Services at (804) 367-1604.
Tests: Medical Examination, Vision Examination, Knowledge Examination or Road Skills Test.
Circumstances: describe in detail the circumstances that led to this request, including what appears to be the driver's medical or visual impairment.
Questions: contact Medical Review Services at 1-804-367-6203 (Voice).
| Question | Answer |
|---|---|
| Form Name | Form MED 3 |
| Form Length | 1 page |
| Fillable? | Yes |
| Fillable fields | 42 |
| Avg. time to fill out | 7 min |
| Edition | 07/01/2024 |
| Issuing agency | Virginia Department of Motor Vehicles |
| Matches the agency's file | Yes, checked October 4, 2026 |
| Other names | MED 3, MED3, Form MED 3, MED 3 form, DMV MED 3, Medical Review Request |
| Official source | Form MED 3 (Rev 07/01/2024), Virginia Department of Motor Vehicles |
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