Forms
This section contains all the forms used by the SAAQ’s medical assessment and behaviour monitoring unit, called the Service de l’évaluation médicale et du suivi du comportement (SEMSC). When the SAAQ asks a driver’s licence holder to provide a medical report, it sends that person one of these forms, which must then be completed by a health care professional.
At this point in time, you must still print out any interactive forms that you complete onscreen and file a paper copy with the SEMSC. However, you should be able to begin filing these forms electronically once our current computer systems have been replaced.
Note: You must work with the existing layout of the forms. The space provided for your answers cannot be increased and the layout of the various sections cannot be changed. If the space provided is insufficient, you can attach a separate sheet.
Declaration of Unfitness to Drive a Motor Vehicle (5626A-30) (PDF, 129.9 KB)
1 page
This form is sent to the SAAQ by a health professional who considers that the state of health of a patient renders that person unfit to drive.
Report on a Person's State of Health (28) (6228A-30)
4 pages
This report serves to assess a driver’s overall state of health.
Eye Examination Report - Ophthalmology or Optometry (5) (6205A-30)
2 pages
This report is requested when a driver’s vision needs to be assessed.
You can refer to the Guide de soutien – Rapport d’examen visuel en ophtalmologie ou en optométrie (in French only).
Functional Assessment Report on Physical and Mental Fitness to Drive (57) (5790A-30)
6 pages
This report is requested when a functional assessment of a person’s physical and mental fitness to drive a road vehicle is required. A road test is involved.
Road Test Report by an Occupational Therapist (58) (5890A-20)
2 pages
This report is requested when the results of a road test are required in order to reassess a person’s fitness to drive.
Medical Cardiovascular Examination Report (11) (6211A-30) (PDF, 174.1 KB)
2 pages
This report is requested when a driver’s cardiovascular health needs to be assessed.
Medical Psychiatric Examination Report (13) (6213A-30) (PDF, 178.6 KB)
2 pages
This report is requested when a driver’s psychiatric health needs to be assessed.
Medical Neurological Examination Report (14) (6214A-30) (PDF, 167.1 KB)
2 pages
This report is requested when a driver’s neurological health needs to be assessed
Medical Otorhinolaryngological Examination Report (18) (6218A-30) (PDF, 156.1 KB)
2 pages
This report is requested when a driver’s hearing, or any otorhinolaryngological (ear, nose and throat (ENT)) condition, needs to be assessed.
This report is requested when the health of a driver with diabetes needs to be assessed.
Accessible Parking Permit Application(6375A-30) (PDF, 411.5 KB)
2 pages
This form serves to assess the disability and limitations of a person with a disability.
Last update: April 8, 2026