Get Di 4p

Filling out the Di 4p form is a necessary step for drivers whose medical conditions may affect their ability to drive safely. This guide provides a step-by-step approach to ensure you complete the form accurately and effectively.

Follow the steps to complete the Di 4p form online.

1. Click ‘Get Form’ button to obtain the Di 4p form and open it in your preferred online editor.
2. Begin with Section 1 titled 'Driver/Applicant Information'. Provide your full name, date of birth, driver's license number, street address, city, state, ZIP code, and phone number for contact during business hours.
3. In Section 2, indicate any medical history by checking each applicable condition, such as cardiovascular problems or diabetes. Include explanations for any checked conditions and list additional health problems, if necessary.
4. Move to Section 3, where you will answer general questions about your driving history and health. Be thorough in your responses, especially regarding any treatment received from traffic accidents or disabilities.
5. Complete Section 4, which includes a certification statement that confirms your information is accurate. Remember to sign this section to validate your application.
6. Have your physician fill out Sections 5 through 7 after your examination. They will review your medical history and provide their recommendation regarding your ability to drive safely.
7. Once all sections are completed and signed, save the form. You can then download, print, or share the form with the required recipients by fax, mail, or email as specified in the instructions.

Ensure you complete the Di 4p form online today to maintain your driving privileges.