Form DP18 "Eye Examination Certificate" - Nevada

What Is Form DP18?

This is a legal form that was released by the Nevada Department of Motor Vehicles - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2007;
  • The latest edition provided by the Nevada Department of Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DP18 by clicking the link below or browse more documents and templates provided by the Nevada Department of Motor Vehicles.

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Download Form DP18 "Eye Examination Certificate" - Nevada

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Driver’s License Review
555 Wright Way
Carson City, NV 89711
Reno/Carson City – (775) 684-4DMV (684-4368)
Las Vegas – (702) 486-4DMV (684-4368)
Rural NV – (877) 368-7828
www.dmvnv.com
Eye Examination Certificate
(NAC 483.310, 483.340)
Name of Applicant
(LAST Name)
(First Name)
(Middle Name)
Applicant’s Date of Birth
Nevada Driver’s License No.
(MM/DD/YYYY)
Applicant’s Address
Applicant’s Phone Number (
)
I,
, certify that I have examined the above-named applicant
(Printed Name of Physician or Optometrist Licensed to Practice in Nevada)
and offer the following record of the eye examination.
With
With New Rx
Without Rx
Current Rx
If Being Changed
Right Eye
........................................................................................................20/
20/
20/
Left Eye
..........................................................................................................20/
20/
20/
Both Eyes
.......................................................................................................20/
20/
20/
Could visual acuity deficiency be corrected with glasses?
...................................................................................... Yes
No
Are glasses being fitted?
Are there any progressive abnormalities?
…Yes
No
.... Yes
* No
Will the applicant’s condition (as described above) impair his/her ability to safely operate a motor vehicle?
. Yes
* No
Yes
*If
, please further explain the case and recommend restrictions:
Duly licensed to practice
in Nevada.
Physician’s Signature
Physician’s Office Street Address
Date of Examination
City, State, and Zip Code
Physician’s Office Telephone Number
Applicant’s Signature
90
PLEASE NOTE:
This Eye Examination Certificate must be presented within
days of the date the examination was
performed by a physician or optometrist licensed to practice in the State of Nevada.
DP18 (Revised 12/2007; replaced form DLD18.)
Driver’s License Review
555 Wright Way
Carson City, NV 89711
Reno/Carson City – (775) 684-4DMV (684-4368)
Las Vegas – (702) 486-4DMV (684-4368)
Rural NV – (877) 368-7828
www.dmvnv.com
Eye Examination Certificate
(NAC 483.310, 483.340)
Name of Applicant
(LAST Name)
(First Name)
(Middle Name)
Applicant’s Date of Birth
Nevada Driver’s License No.
(MM/DD/YYYY)
Applicant’s Address
Applicant’s Phone Number (
)
I,
, certify that I have examined the above-named applicant
(Printed Name of Physician or Optometrist Licensed to Practice in Nevada)
and offer the following record of the eye examination.
With
With New Rx
Without Rx
Current Rx
If Being Changed
Right Eye
........................................................................................................20/
20/
20/
Left Eye
..........................................................................................................20/
20/
20/
Both Eyes
.......................................................................................................20/
20/
20/
Could visual acuity deficiency be corrected with glasses?
...................................................................................... Yes
No
Are glasses being fitted?
Are there any progressive abnormalities?
…Yes
No
.... Yes
* No
Will the applicant’s condition (as described above) impair his/her ability to safely operate a motor vehicle?
. Yes
* No
Yes
*If
, please further explain the case and recommend restrictions:
Duly licensed to practice
in Nevada.
Physician’s Signature
Physician’s Office Street Address
Date of Examination
City, State, and Zip Code
Physician’s Office Telephone Number
Applicant’s Signature
90
PLEASE NOTE:
This Eye Examination Certificate must be presented within
days of the date the examination was
performed by a physician or optometrist licensed to practice in the State of Nevada.
DP18 (Revised 12/2007; replaced form DLD18.)