Department for Planning and Infrastructure - Government of Western Australia
 
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DPI Home | Licensing Home | Your licence | About your driver's licence | Mandatory reporting of medical conditions | Notification of a medical condition

Notification of a medical condition

As a driver, you are required to inform the Department for Planning and Infrastructure of any medical condition which may impair you ability to drive.

You may be required to provide additional information about the medical condition or undertake an assessment so that a decision may be made about your continued fitness to drive.

Please fill in the form below. For further information please see the Mandatory medical reporting section for more information.

Your details

Driver licence number
Date of birth (dd/mm/yyyy)
Surname
Other names
Residential address Post code
Postal address Post code
   
Contact number
Email address
   

Medical condition details

Eyesight medical conditions

Do you need to wear visual aids for driving?

No
Yes - A condition will be added to your driver's licence requiring you to wear visual aids when driving.
   
Do you have any other vision or eye dis-orders?
No
Yes Please detail:
   
Other medical conditions that may impair your driving ability
Do you have any permanent or long term mental disorder or physical disability that has not previously been reported to Licensing?
No
Yes Please detail:
   
Has there been a deterioration of your medical condition about which you have previously notified Licensing?
No
Yes Please detail:


 


Department for Planning & Infrastructure