How to Fill Out the Florida Mature Driver Vision Test Form (HSMV 72119)

If you are 80 or older and want to renew your Florida driver license online or by mail, the Florida HSMV 72119 form is how your eye doctor certifies that your vision still meets state standards. It is a one-page document: you fill in a short authorization at the top, a Florida-licensed MD, DO, or optometrist (or a physician at a federal VA hospital) records your visual acuity and signs the certification, and the results reach the Division of Motorist Services either electronically from the doctor or on paper from you.

When You Need the Form

Florida gives drivers 80 and older two ways to satisfy the vision requirement at renewal. Walk into any driver license service center and staff will screen your vision on the spot at no charge, and no HSMV 72119 is needed. If instead you want to renew through a convenience service — online or by mail — a qualified eye care professional must examine you, record the results on HSMV 72119, and get them to the state before you can finish the renewal remotely.¹

One point catches people out. If your doctor has not submitted the results electronically in advance, the online and mail options are closed to you.¹ Ask your provider up front whether they will transmit the results through the state’s approved system, or plan to hand-carry the completed paper form to a service center.

Who Can Sign the Form

The certification block on HSMV 72119 requires the practitioner to confirm they belong to one of four groups:²

Medical doctors (MDs) licensed under Florida Chapter 458
Osteopathic physicians (DOs) licensed under Florida Chapter 459
Optometrists licensed under Florida Chapter 463
Licensed physicians at a federally established veterans’ hospital

An eye doctor licensed only in another state cannot complete this form, with the single exception of a physician practicing at a federal VA hospital. If you spend part of the year outside Florida, schedule the exam with a Florida-licensed provider before you leave, or plan to visit a service center during a return trip and use the free on-site screening.

How to Fill Out HSMV 72119

You can download the form from the FLHSMV website or pick one up at any driver license office. It has two parts.

Your Section

At the top, print the doctor’s full name in the authorization line. This is what gives the practitioner permission to examine you and send the results to the Division of Motorist Services. Then sign your name and add your driver license number, street address, and city, state, and zip.²

The Doctor’s Section

The practitioner fills in your name and date of birth, then records distant visual acuity for three measurements: right eye alone, left eye alone, and both eyes together. Each measurement has a line for uncorrected vision and a line for best-corrected vision. If you wear glasses or contacts to reach the standard, the corrected numbers are the ones that count, and the split between corrected and uncorrected results is how the department decides whether to add a corrective-lens restriction to your license.²

The doctor signs the certification, prints their name, provides their professional license number, and dates the form. Check that every field is legible. Staff can reject a form on which the license number or acuity scores can’t be read.

Watch the date. The completed form expires one year from the day of the examination.² Have your eyes checked too far in advance of renewal and you will need a fresh exam.

The Vision Numbers Behind the Form

Florida’s vision standards for a passenger license work on a sliding scale, and the acuity your doctor writes on the form is measured against them:³

20/40 or better in each eye passes the standard screening without restriction.
20/50 or worse in either eye triggers a referral to an eye specialist, with a 60-day temporary permit so you can keep driving in the meantime.
20/70 in either eye or both eyes together can still be licensed if the vision cannot be improved further, but if one eye is blind or 20/200 or worse, the other must be 20/40 or better.
20/80 or worse with both eyes is not licensable.

Submitting the Form and Finishing the Renewal

You have three paths, depending on how the doctor handled the results.

Electronic submission by the doctor. Your physician or optometrist can transmit results directly through the department’s approved electronic system. Once they land in the state’s records, you can finish your renewal online or by mail without sending the paper form yourself.¹
In person at a service center. Bring the completed paper form to any driver license office. Staff will review the results, enter them, and process the renewal, including a new photo if one is needed.⁴
Mail. Send the original signed form to the Division of Motorist Services in Tallahassee. Confirm the current mailing address on the FLHSMV website before you send it.

The renewal fee for a standard Class E license is $48. Renewing at a tax collector’s office adds a $6.25 service fee, though veterans who have documented their status are exempt from that surcharge.⁵ The renewed license is valid for six years, and the vision requirement repeats at the next renewal.

If the Exam Shows a Problem

A referral is not the end of your license. On a first below-standard reading, the office issues a 60-day temporary permit so you can drive while you see an eye specialist. If the specialist finds a condition that might be corrected, they complete a different document, the Report of Eye Exam (HSMV 72010), rather than HSMV 72119.⁴ Your eye doctor will know which form applies.

If your acuity falls below the licensable minimum and cannot be corrected, the department revokes the license for inadequate vision. Drivers 80 and older who lose a license this way receive a Florida state identification card at no charge.¹

Scheduling the eye exam a few months before your license expires gives you room to handle any referral without pressure on the calendar.

1
Florida Senate. Florida Code 322.18 – Original Applications, Licenses, and Renewals; Expiration of Licenses; Delinquent Licenses
2
Florida Department of Highway Safety and Motor Vehicles. Mature Driver Vision Test (HSMV 72119)
3
Cornell Law Institute. Florida Administrative Code Annotated R 15A-5.011 – Vision Standards
4
Florida Department of Highway Safety and Motor Vehicles. Driver License Renewal Requirements/Options for Older Drivers
5
Florida Department of Highway Safety and Motor Vehicles. Fees