The DMV DLD 100 form is a crucial document used for the renewal of a driver’s license by mail in Nevada. It requires a physical evaluation, including a vision report from a licensed eye care professional and a medical report from a physician, ensuring that all applicants meet the necessary health standards for safe driving. To get started on your renewal process, make sure to fill out the form by clicking the button below.
Central Services and Records Division
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
Rural Nevada (877) 368-7828
Website: www.dmvnv.com
Physical Evaluation Form
Driver’s License Renewal by Mail
NRS 483.383-483.384, NAC 483.420-483.455
Sections 1 and 2 must be signed and dated not more than 90 days before the date this form is submitted to the Nevada DMV. Section 1, the Vision report, must be completed, signed, and dated by a licensed ophthalmologist, optometrist, or physician. Section 2, the Medical report, must be completed, signed, and dated by a licensed physician. Please return this Physical Evaluation Form with your application and fees payment to renew your driver’s license by mail. Unless otherwise instructed, all parts of this form must be completed in full to avoid any delays of your renewal.
Please clearly PRINT the following information:
Driver’s Name _____________________________________________________________________________________
Address __________________________________________________________________________________________
Driver’s License Number _______________________ Date of Birth ______________________ Age
Section 1 – Vision (must be completed by licensed ophthalmologist, optometrist or physician)
Without Corrective Lenses
With Corrective Lenses
Right Eye
20/
Left Eye
Both Eyes
Does this person have a progressive disease or condition of the eye?
.........................................................
Yes
No
_______________________________________________________
________________________________
Signature of Licensed Ophthalmologist, Optometrist, or Physician
Date of Vision Examination
(Must be within the last 90 days)
(
)
PRINTED Name of Ophthalmologist, Optometrist, or Physician License Number
Area Code and Phone Number
_________________________________________________________________________________________________
Office Address of Ophthalmologist, Optometrist, or Physician
Section 2 - Medical (must be completed by a licensed physician)
Does a medical condition exist that would prevent this patient from operating a motor vehicle safely?........ Yes No
If “Yes,” please explain: _____________________________________________________________________________
Is this patient taking any medication that would affect his/her ability to drive safely? .................................... Yes No
Signature of Licensed Physician
Date of Medical Evaluation
PRINTED Name of Physician Physician’s License Number
Physician’s Area Code & Phone No.
Office Address of Physician
DLD-100 (Revised 01/2009)
Filling out the DMV DLD 100 form is a straightforward process, but it’s essential to complete each section accurately. This form requires input from licensed professionals, so be prepared to visit an ophthalmologist or physician. Once you have all the necessary information, you can submit the form along with your application and payment to renew your driver’s license by mail.
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What is the DMV DLD 100 form?
The DMV DLD 100 form is a Physical Evaluation Form required for renewing a driver's license by mail in Nevada. It includes two sections: a vision report and a medical report. Both sections must be completed by licensed professionals and submitted with the renewal application and payment.
Who needs to fill out the DLD 100 form?
Individuals renewing their driver's license by mail must complete the DLD 100 form. This requirement applies if they are instructed to provide medical documentation or if they have specific medical conditions that could affect their ability to drive safely.
What are the requirements for completing the vision section?
The vision section of the DLD 100 form must be completed by a licensed ophthalmologist, optometrist, or physician. This section assesses the individual's vision with and without corrective lenses. The vision examination must be conducted within 90 days prior to submitting the form.
What information is needed in the medical section?
The medical section requires a licensed physician to evaluate whether any medical conditions or medications could impair the individual's ability to operate a motor vehicle safely. This section also must be signed and dated by the physician within 90 days of submission.
How should the DLD 100 form be submitted?
The completed DLD 100 form must be returned along with the driver's license renewal application and payment. It is crucial to ensure that all parts of the form are filled out completely to avoid delays in the renewal process.
What happens if the DLD 100 form is not completed correctly?
If the DLD 100 form is not completed in full or if any required signatures are missing, the renewal application may be delayed. It is essential to double-check all information and ensure that it is accurate before submission.
Is there a specific timeframe for submitting the DLD 100 form?
The vision and medical evaluations must be conducted within 90 days before the form is submitted to the Nevada DMV. Therefore, it is important to plan ahead to ensure timely renewal of the driver's license.
Where can I find more information about the DMV DLD 100 form?
For additional information, you can visit the Nevada DMV website at www.dmvnv.com. You may also contact the Central Services and Records Division at (775) 684-4DMV (4368) or the Las Vegas area at (702) 486-4DMV (4368) for assistance.
Not signing and dating the form: Sections 1 and 2 must be signed and dated within 90 days of submission. Failing to do this can lead to immediate rejection of the application.
Incomplete Vision Report: Ensure that the vision report is fully completed by a licensed ophthalmologist, optometrist, or physician. Missing information can cause delays.
Medical Report not filled out: Section 2 must be completed by a licensed physician. Omitting this step can result in processing issues.
Incorrectly filling out personal information: Clearly print your name, address, driver’s license number, date of birth, and age. Errors can lead to confusion and delays.
Not providing recent evaluations: Both the vision and medical evaluations must be conducted within the last 90 days. Older evaluations will not be accepted.
Failing to include contact information: Ensure that the area code and phone number of the physician and ophthalmologist are included. Missing contact details can hinder communication.
Ignoring medication disclosures: If the patient is taking medication that affects driving ability, it must be disclosed. Failure to do so can have serious consequences.
Not submitting the form with the application: Remember to return the Physical Evaluation Form along with your application and payment. Incomplete submissions will delay processing.
The DMV DLD 100 form is a crucial document for renewing a driver’s license in Nevada. To ensure a smooth renewal process, several other forms and documents may be needed alongside it. Below is a list of these additional forms that are often required or recommended.
Being prepared with these documents can help streamline the renewal process for your driver’s license. Ensure that everything is filled out correctly and submitted on time to avoid any delays.