| Forms, Brochures & Training |
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| Overview |
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This page provides forms, brochures and training resources pertaining to the Medically At-Risk Driver Program.
Use the links below to go directly to any section:
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| Forms |
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Available Forms
DMV provides two forms for reporting drivers under the Medically At-Risk Driver Program:
Form Name: Mandatory Impairment Referral Form
Form Number: 7230
Stock Number: 300457
Example: Sample of Completed Form
Use: Physicians and other health care providers MUST use this form to submit their reports as part of the mandatory reporting program.
Form Name: Driver Evaluation Request Form
Form Number: 6066
Stock Number: 300230
Use: Physicians, health care providers, social service providers and family members MAY use this form to report an unsafe driver as part of the voluntary reporting program. They may also submit a letter on their agency/organization letterhead so long as it contains the same information.
Viewing Forms
To view forms, click on the form names above.
Downloading/Printing Forms
Forms may be downloaded and printed directly from the Internet, using your browser's "Save As" and "Print" options while viewing them.
Click here for helpful information about DMV forms and publications>>.
Note: Be sure to print forms on plain white paper.
Ordering Forms
Forms may be ordered in bulk from the ODOT Storeroom. To do so, fax a request on your agency/organization letterhead directly to the storeroom at (503) 986-2801.
Be sure to include the following in your request:
- Form Name*
- Form Number*
- Stock Number*
- Your contact and mailing information, if different than your letterhead
* Listed above.
Submitting Forms
Completed forms and letters may be faxed to DMV's Driver Safety Unit at (503) 945-5329, or mailed to:
DMV Driver Safety Unit
1905 Lana Ave., NE
Salem, OR 97314-4120
Click here for more information on WHEN to submit reporting forms to DMV>>.
Click here for more information on HOW to submit reporting forms to DMV>>.
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| Brochures |
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Available Brochures
DMV provides a series of brochures that can be used in talking to patients about safe driving, and planning for a time when they may want to consider “retiring” from driving:
Viewing Brochures
To view color copies of brochures, click on the images or form names above.
Downloading/Printing Brochures
Brochures may be downloaded and printed directly from the Internet, using your browser's "Save As" and "Print" options when viewing them.
Click here for helpful information about DMV forms and publications>>.
Note: The brochures are in a two-sided, tri-fold format. This means that they are designed to be printed on both sides of a single page and then folded in thirds. This requires duplex printing capabilities, or each side may be printed on a separate page and then converted by a photocopier with 1 to 2 side conversion capabilities.
Ordering Brochures
Black and white copies of brochures can be ordered in quantities of 50 from the ODOT Storeroom. To do so, fax a request on your agency/organization letterhead directly to the storeroom at (503) 986-2801.
Be sure to include the following in your request:
- Form Name*
- Form Number*
- Stock Number*
- Your contact and mailing information, if different than your letterhead.
* Listed above.
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| Online Training Presentation |
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DMV provides a 12 minute online training presentation on the Medically At-Risk Driver Program.
Click here to launch the online training presentation>>.
Note: Your computer's processing, video, audio and network capabilities may impact the actual speed and quality.
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| Training Video |
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DMV provides an 18 minute training video on the Medically At-Risk Driver Program. It is available in both VHS and DVD formats and will be mailed within five business days from receipt of an order.
Click here to order a training video>>.
Note: When ordering, be sure to select your video format preference, i.e., VHS or DVD. The default is VHS.
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| Questions |
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Questions about the forms, brochures, training materials provided on this page and the Medically At-Risk Driver Program may be submitted to DMV via phone or email.
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| Related Information |
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Additional information that may be relevant includes:
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