Department of State GrowthTransport

Medical declaration

Please use this form to advise us of medical conditions you have not advised us of previously.

Your surname
Your driver licence number
Your date of birth
Your contact phone number
Do you have: 
  • - heart disease?
  • - sleep apnoea?
  • - frequent fainting?
  • - giddy attacks?
  • - epilepsy?
  • - diabetes?


    (If so, how is your diabetes controlled?)

Do you have any other medical condition or physical or mental disability which may affect your driving?

Do you need to use prescription glasses or contact lenses when driving?
Have you had a fit or convulsion in the last 5 years?