SFN 4569 Medical Examination Report – Fillable PDF

The SFN 4569 is the North Dakota Department of Transportation (NDDOT) medical examination report required for drivers who need a professional health‑care provider’s assessment. This form must be completed on a fillable PDF, signed by the provider, and submitted to the DOT.

What Is the SFN 4569 Form?

SFN 4569 is used to document a driver’s medical fitness for operating a motor vehicle. It includes sections for personal information, medical history, vision, hearing, and the provider’s certification.

How to Complete the SFN 4569 Online

Instead of printing and scanning, you can fill out the form directly in your browser using Formize’s PDF Filler app. Follow these simple steps:

1. Click the "Fill out this form" button on this page.
2. Wait a few seconds while the Formize PDF Filler loads.
3. Enter the required information in each field. All fields are interactive and auto‑save.
4. When finished, click "Save & Download" to get a completed PDF you can email or print.

Common Mistakes to Avoid

• Leaving required fields blank: The form will not submit if mandatory sections are empty.
• Using the wrong date format: Use MM/DD/YYYY as required by NDDOT.
• Forgetting the provider’s signature: An unsigned form is rejected.
• Submitting a non‑fillable PDF: Always use the official fillable version linked below.

Where to Submit the Completed Form

After saving the completed PDF, send it to the address or fax number indicated on the form’s last page, or upload it through your local NDDOT portal. Keep a copy for your records.

Need the official fillable PDF? Download SFN 4569 PDF now and start filling it out instantly.