Please complete the form in full. At least one disability must be marked.
Age: a person's age shall not be a factor in determining a disability.
Conditions: a chiropractor, podiatrist, or optometrist may only issue and sign this form for those conditions which he or she is legally authorized to diagnose and treat.
Expiration: upon expiration, a Temporary Placard may be renewed once for an additional 180 days, provided the applicant reapplies and submits a new Physician's Statement.
Temporary period: if the temporary period of disability is not specified, a Temporary Placard will be issued only for a period of 30 days.
| Question | Answer |
|---|---|
| Form Name | Form 1776 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 27 |
| Avg. time to fill out | 5 min |
| Edition | Rev 08-2026 |
| Valid for | 90 days |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | 1776, Form 1776, MO Form 1776, Physician's Statement for Disabled License Plates or Placards, Missouri disabled placard form |
| Official source | Form 1776 (Rev 08-2026), Missouri Department of Revenue |
Physicians Statement For Placard Form isn’t the one you’re looking for?