Form VS-017 template
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Driver Eyesight Evaluation
To be completed upon DMV request and/or to have the eyeglass restriction removed from your Vermont drivers license.
The document is a form for evaluating an applicant's eyesight for the purpose of obtaining or renewing a Vermont operator's license. Applicants must undergo an examination by a licensed optometrist or ophthalmologist to determine their eyesight status. The form includes sections for the applicant's personal information, such as name, mailing and residential addresses, drivers license number, date of birth, place of birth, and contact details. The form also requires responses regarding ocular coordination, visual field, color vision, and visual acuity. The optometrist/ophthalmologist is required to indicate their professional opinion on the applicant's eyesight based on the examination results and provide their printed name, license number, state of license, address, title, phone number, and signature.
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