The Virginia DMV MED 4 form, officially the Customer Vision Report, is how you prove your eyesight meets state driving standards when a DMV office screening isn’t the right path. You fill in the identifying information at the top, your ophthalmologist or optometrist completes the examination section, and the signed report goes to Medical Review Services in Richmond by mail or fax within 90 days of the exam.1Virginia Department of Motor Vehicles. Customer Vision Report MED 4
When You Need To Submit a MED 4
The form itself names four situations. You failed the vision screening at a DMV office. You are currently on vision review with the DMV. You want your own eye doctor to test your vision instead of using the in-office screening. Or you are seeking a commercial driver’s license vision waiver.1Virginia Department of Motor Vehicles. Customer Vision Report MED 4 If you failed the screening at a counter, the examiner will tell you to see an eye care professional and bring the completed MED 4 back.2Virginia Department of Motor Vehicles. Vision Requirements Overview
What You Fill In Before the Appointment
The top of the form is yours. Enter your last name, first name, middle initial, and any suffix. Then provide either your DMV customer number (printed on your driver’s license) or your Social Security number, plus your date of birth. These fields are how Medical Review Services matches the report to your driving record, and a wrong customer number is a common cause of processing delays. Check it against your license before you hand the form to the doctor.1Virginia Department of Motor Vehicles. Customer Vision Report MED 4
What the Eye Doctor Completes
The rest of the form is clinical and must be filled in by an ophthalmologist or optometrist during your exam. Expect them to record:1Virginia Department of Motor Vehicles. Customer Vision Report MED 4
- The date of the first examination and the date of the most recent examination.
- All visual and ocular conditions, with a yes-or-no indication of whether any condition could affect your ability to drive.
- Uncorrected visual acuity for the right eye, the left eye, and both eyes together.
- Best corrected visual acuity (with your glasses or contacts) for right, left, and both.
- Horizontal visual field: temporal (0–100 degrees) and nasal (0–60 degrees) for each eye.
- Any provider comments the doctor considers relevant.
If any condition affects your peripheral vision, the doctor also has to attach a graphic visual field analysis to 120 degrees total in each eye, preferably an HVF 30-2 and 60-4 or an equivalent threshold perimetry test.3Virginia Department of Motor Vehicles. Revised DMV Vision Form MED 4
Finally, the provider signs and dates a certification block that includes their printed name, medical license number, license expiration date, issuing state, business address, phone, and fax. A report missing the signature or license number will be returned unprocessed, so look over the bottom of the form before it leaves the office.
The Vision Standards the DMV Is Checking
Knowing the thresholds helps you read your own results. Virginia Code § 46.2-311 sets two benchmarks for an unrestricted license: visual acuity of at least 20/40 in one or both eyes (with or without corrective lenses) and a horizontal field of at least 110 degrees.4Virginia Code Commission. Virginia Code 46.2-311 – Persons Having Defective Vision
If your acuity falls between 20/40 and 20/70, or your field is between 70 and 110 degrees, you can still be licensed, but only for daylight driving: from one-half hour after sunrise to one-half hour before sunset. For a driver with vision in only one eye, the daylight-only field requirement is at least 40 degrees temporal and 30 degrees nasal.4Virginia Code Commission. Virginia Code 46.2-311 – Persons Having Defective Vision Fall below those numbers entirely and the DMV cannot license you on the MED 4 alone.
Where To Send the Completed Form
The MED 4 does not go to your local DMV office. It goes to Medical Review Services in Richmond, and it must arrive within 90 days of the examination. Anything older is rejected.3Virginia Department of Motor Vehicles. Revised DMV Vision Form MED 4 Many eye doctors’ offices will mail or fax the report directly for you; ask before you leave the appointment.5Virginia Department of Motor Vehicles. DMV Medical Review of Drivers
- Mail: Virginia Department of Motor Vehicles, Medical Review Services, PO Box 27412, Richmond, VA 23269-0001
- Fax: (804) 367-1604
Keep a photocopy of the signed form, and if you fax it, keep the transmission confirmation page. To check status, call Medical Review Services at (804) 367-6203, or (800) 272-9268 for deaf or hearing impaired callers.6Virginia Department of Motor Vehicles. MED 3 Medical Review Request
What Happens After You Submit
Medical Review Services compares the clinical findings to the statutory thresholds and sends its decision by mail. Depending on your numbers, the outcome will be one of the following:
- An unrestricted license, if your acuity is 20/40 or better and your horizontal field is at least 110 degrees.
- A daylight-only restriction, if your acuity falls between 20/40 and 20/70 or your field falls between 70 and 110 degrees.4Virginia Code Commission. Virginia Code 46.2-311 – Persons Having Defective Vision
- Periodic re-evaluation, if you have a progressive condition such as retinitis pigmentosa or glaucoma. These trigger annual review, with updated visual field testing whenever changes are reported, or at a minimum every three years.1Virginia Department of Motor Vehicles. Customer Vision Report MED 4
- Suspension, if you fall below the minimum standards entirely. Notice goes to the address on your driving record.
Any restriction placed on your license is enforceable the same as any other licensing condition. Driving outside a restricted license is treated the same as driving on a suspended license.
If You Disagree With the Decision
You can request an administrative fact-finding hearing under Virginia Code § 2.2-4019. Send a written request, with a working daytime phone number, to Medical Review Services at the same PO Box 27412 address or fax number used for the form. Hearings are usually held by teleconference, though you can appear in person at DMV headquarters in Richmond, and you can bring updated exam results or a second opinion. Results take up to six weeks.7Virginia Department of Motor Vehicles. Appeals Process
If You Hold a CDL
The MED 4 covers Virginia’s state requirements. It is not the federal vision form. If you don’t meet the FMCSA distant visual acuity or field of vision standard in your worse eye, you also need a Vision Evaluation Report (Form MCSA-5871) signed by an ophthalmologist or optometrist, and your CDL medical examination has to begin within 45 days of that signed report, with annual medical certification after that.8Federal Motor Carrier Safety Administration. Vision Evaluation Report Form MCSA-5871 Confirm with your medical examiner whether you need both.