Check your answers before sending your application

• IMPORTANT: Please answer the questions in BLOCK CAPITAL letters using BLACK INK. Failure to provide full information for yourself, GP or consultant may result in your case being delayed.: Change
• Title: Change
• Full name: Change
• Date of birth: Change
• Address: Change
• Postcode: Change
• Email: Change
• Contact number: Change
• Change of details: Change
• GP name: Change
• Surgery name: Change
• Address: Change
• Town: Change
• Postcode: Change
• Contact number: Change
• Email: Change
• Date last seen for this condition: Change
• Consultant name: Change
• Speciality: Change
• Department: Change
• Hospital name: Change
• Address: Change
• Town: Change
• Postcode: Change
• Contact number: Change
• Email: Change
• Date last seen for this condition: Change
• What is your vision condition?: Change
• How many functioning eyes do you have?: Change
• Which eye does your condition affect?: Change
• Have you ever had laser treatment for an eye condition?: Change
• If yes, have you told us about your most recent laser treatment?: Change
• Has a consultant or eye specialist said you have a problem with your field of vision?: Change
• If yes, is your visual field problem caused solely by an eye condition?: Change
• If no, is your visual problem caused by any of the following?: Change
• Do you have double vision?: Change
• How is your double vision (diplopia) controlled?: Change
• Have you ever seen an eye specialist about your double vision (diplopia)?: Change
• Have you had contact (by phone, video, or face to face consultation) with your eye specialist about your double vision (diplopia) in the last 12 months?: Change
• 3.5 You must confirm you've read and understood the following information on double vision: Change
• Do you meet the minimum eyesight standard for driving?: Change
• Applicant's authorisation: Change
• Name: Change
• Signature: Change
• Date: Change
• I authorise the Secretary of State to correspond with medical professionals by email.: Change
• If you would like to be contacted about your application by email or text message (SMS), please tick the appropriate boxes. If not, DVLA will continue to contact you by post.: Change
• If you would like to be contacted about your application by email or text message (SMS) by a healthcare professional acting on behalf of DVLA, please tick the appropriate boxes. If not, you'll be contacted by post.: Change

Now send your application

By submitting this application you are confirming that, to the best of your knowledge, the details you are providing are correct.