Tennessee Drivers License Form PDF Details

Navigating the roads of Tennessee requires not only skill but also clear vision. Recognizing this, the Tennessee Department of Safety and Homeland Security has put a procedure in place to ensure drivers meet the necessary vision standards to drive safely. This process begins at the Driver Service Center, where a preliminary vision screening may indicate the need for a more thorough examination. In such cases, individuals are directed to seek further assessment from a licensed eye care professional, either an optometrist or ophthalmologist. This is where the Tennessee Drivers License Vision Examination Form comes into play. It is a crucial document designed to capture the outcome of this detailed eye examination. The form is comprehensive, covering everything from basic personal information to specific vision metrics such as acuity for both eyes, with and without corrective lenses, field of vision, and color vision testing. Additionally, it inquires about the necessity for glasses for distant vision, any existing eye conditions, and whether treatment or corrective lenses could improve the driver's eyesight. Importantly, the form includes a section for the eye care professional's certification, verifying the accuracy of the examination results. This document then accompanies the driver as they return to the Driver Service Center, potentially with a new pair of glasses or lenses, to complete their application for a driver's license. It's a systematic approach to ensuring the safety of the driver and others on the road by addressing vision impairments that could interfere with safe driving.

QuestionAnswer
Form NameTennessee Drivers License Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namestennessee vision requirements, eye driver tennessee, tennessee vision dmv vision form, tn dmv vision test

Form Preview Example

TENNESSEE DEPARTMENT OF SAFETY

AND HOMELAND SECURITY

VISION EXAMINATION FORM

Important information for Driver Applicant

The vision screening by a Driver License Examiner indicates there is a possible vision impairment that would affect your ability to safely operate a motor vehicle. You are being asked to have your vision checked by a licensed eye care Doctor of Optometry or Doctor of Ophthalmology to determine whether your vision can be improved by eye glasses or eye treatment.

If you have any questions about how well you must be able to see to drive on the streets and highways of Tennessee, the Driver’s License Examiner will be glad to assist you.

Driver License Examiners are prohibited from referring you to or recommending the name of an eye specialist.

When you return to the Driver Service Center after your eye examination, you must bring this completed form by your eye doctor, along with any new eye glasses or corrective lenses.

FOR DOCTOR OF OPTOMETRY OR OPHTHALMOLOGY ONLY

Important information for the Eye Care Provider

All applicants for a driver license as well as drivers whose record cast doubt on their ability to drive safely, are given vision screenings by the Driver License Examiners. When this screening indicates that a vision examination is needed by an eye care professional, the person is asked to visit a vision specialist.

Upon completion of your eye examination of the driver applicant, please completely fill out this form and certification. Please have patient sign this form in your presence.

No recommendations or suggestions are given by the Tennessee Department of Safety and Homeland Security Driver License Examiners as to which eye specialist to visit. This report can only be accepted from a licensed Doctor of Optometry or Doctor of Ophthalmology.

Full Name of Person Examined: _________________________________________________________________________________________

FirstMiddleLast Name

Street Address: __________________________________________________________ City ______________________________________________ State ___________ Zip Code ___________

ACUITY

RIGHT EYE

LEFT EYE

BOTH EYES

FIELD OF VISON

 

 

 

 

 

 

 

 

 

 

WITH PRESENT

 

 

 

TO RIGHT OF POINT OF

20/

20/

20/

FIXATION

GLASSES (IF ANY)

 

 

 

 

 

 

 

 

 

 

20/

20/

20/

TO LEFT OF POINT OF FIXATION

WITHOUT GLASSES

 

 

 

 

 

 

WITH BEST

 

 

 

TOTAL ANGLE

POSSIBLE

20/

20/

20/

 

CORRECTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COLOR TEST

 

 

 

 

 

 

 

 

 

SF-0257 (Rev. 1/12)

(OVER)

- 1 -

RDA 1348

TENNESSEE DEPARTMENT OF SAFETY

VISION EXAMINATION FORM

1.Are glasses needed for distant vision? ___________________ Are they being prescribed or fitted?________________

2.Describe any irregularities such as : Double vision, poor night vision, eye injury, eye disease, poor near vision, etc:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

3.Will eye glasses improve conditions described in Question 2 above?_______________________________________

4.Will other treatments improve above-described conditions for the eyes? ____________________________________

__________________________________________________________________________________________________

5.Is the person named in this report currently undergoing the recommend treatment to improve vision? ______________

6.Additional Comments:

__________________________________________________________________________________________________

CERTIFICATION OF OPHTHAMOLOGIST OR OPTOMETRIST

I, _____________________________________________________________, being licensed to practice in the

specialty of eye care, in the State of ___________________________________, certify I have personally

examined the eyes of the above named. A true record of this examination appears on this report and he or she signed below in my presence.

Signature of Examining Doctor ______________________________________ DATE _________________

Medical License Number ________________________________________ STATE _________________

Office Address ________________________________________________City _________________________

STATE _____________ ZIP CODE _____________Office Telephone Number ________________________

Signature of Person ____________________________________________ DATE _____________________

Receiving Eye Examination

SF-0257 (Rev. 1/12)

- 2 -

RDA 1348

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Step # 2 of submitting tennessee drivers vision

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