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Filling out the Cocodoc.comform85779579 is essential for submitting your visual examination report to the Department of Licensing. This guide will walk you through the steps to ensure you complete the form accurately and efficiently.

Follow the steps to complete the visual examination report form.

1. Click the ‘Get Form’ button to access the visual examination report and open it in the online editor.
2. Begin by filling in the driver/patient information section. Enter the name (Last, First, Middle), date of birth, and daytime telephone number, including the area code.
3. Input the driver's license number in the designated field to identify the individual linked to the report.
4. Provide consent for information release by checking the authorization box. This allows the ophthalmologist or optometrist to share details regarding the visual condition.
5. In the section for the health professional's details, the ophthalmologist or optometrist must document their name, professional license number, and contact details.
6. Address the questions regarding the individual's visual acuity and eye conditions by providing details for both with and without correction as specified.
7. After completing all sections, review the form for accuracy before signing. The driver must sign and date where indicated. If the patient is a minor, a parent or guardian should sign as well.
8. Finally, once all information is complete and verified, you can either save changes, download, print, or share the filled form as needed.

Complete your visual examination report online today to ensure a smooth licensing process.