Get Vision Screening Certificate

The Vision Screening Certificate is a crucial document for individuals applying for a Class D or M learner’s permit or driver’s license. This guide provides step-by-step instructions on how to complete the form online, ensuring that all necessary information is accurately submitted.

Follow the steps to complete your Vision Screening Certificate online.

1. Click ‘Get Form’ button to obtain the Vision Screening Certificate and open it in your preferred editing tool.
2. In the 'Applicant Information' section, enter your last name, first name, middle name, suffix, Massachusetts Driver’s License number, and phone number. Ensure that all details are accurate and clearly legible.
3. In the 'Vision Screening Data' section, provide your visual acuity measurements for both eyes without corrective lenses and with corrective lenses. Fill in the values for the right eye (OD), left eye (OS), and both eyes (OU) as applicable.
4. Fill out the total horizontal visual field measurement for both eyes combined. This should be recorded in degrees.
5. Indicate whether glasses or contact lenses are needed for driving by selecting 'Yes' or 'No'.
6. Answer all additional questions related to the use of bioptic telescopic lenses and other vision conditions, ensuring to check all relevant boxes that apply to your situation.
7. In the 'Vision Screening Analysis' section, the ophthalmologist or optometrist must provide their assessment of your vision, confirming whether you meet the visual standards required for driving.
8. Finally, ensure that the medical professional signs and dates the certificate, as well as providing their Massachusetts registration number and office phone number.
9. After completing the form, review all information for accuracy. You can then save changes, download a copy of the form, print it, or share it as needed.

Complete your Vision Screening Certificate online today to ensure a smooth application process.