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The DMV DS 699 form serves as a vital tool for individuals concerned about a driver's ability to operate a vehicle safely. This document allows anyone, whether a relative, friend, caregiver, or medical specialist, to formally request a reexamination of a driver's skills and competencies. If you believe that a driver may be exhibiting dangerous behaviors or experiencing conditions that could impair their driving ability, completing this form is an appropriate step. It's essential to provide specific details regarding the driver’s condition, including medical, physical, or emotional factors, as well as observed driving behaviors that raise red flags. Confidentiality is assured; you may choose to keep your identity hidden when submitting your request. Submissions can be made in person at any DMV location or via mail to the appropriate Driver Safety Office. Remember, all required fields must be completed for your request to be processed. Your concerns could play a critical role in ensuring safety on the roads for everyone.

Dmv Ds 699 Example

A Public Service Agency

INSTRUCTIONS:

REQUEST FOR DRIVER REEXAMINATION

1.Complete this form if you wish the Department of Motor Vehicles (DMV) to reevaluate a driver's ability to drive safely.

2.Sign this request in the signature block provided. You may request that your name not be revealed to the individual being reported. Confidentiality will be honored to the fullest extent possible.

3.Take your completed request to any DMV office or mail to: DMV, Driver Safety Office (see addresses on the next page for your local office.)

Note: All fields marked with an asterisk (*) are required.

NAME OF PERSON BEING REPORTED (FIRST, M.I., LAST)*

DATE OF BIRTH OR APPROXIMATE AGE*

 

TELEPHONE NUMBER

 

 

 

(

)

DRIVER LICENSE NUMBER

VEHICLE LICENSE PLATE NUMBER, IF AVAILABLE

 

 

 

 

 

 

 

STREET ADDRESS*

CITY*

STATE*

 

ZIP CODE*

DRIVERCONDITION—Check all appropriate boxes below. Please use the space below to provide specific details, if known, about the driver's medical (physical or mental) condition such as name of disease or illness, any medications taken, etc.

Medical Condition

Physical Condition

Mental/Emotional Condition Vision Condition

Weakness or Coordination Problems Difficulty Walking

Confused/Disoriented

Alcohol/Drug Use (Describe below) Blackouts, Seizures, Fainting Spells

Needs help with daily activities (i.e., cooking, dressing, bathing, balancing checkbook)

Other:

DRIVER BEHAVIOR—Check appropriate boxes for driving problems you have observed: (Use space below if needed for additional comments.)

Does not see or react to other cars, pedestrians, etc.

Drives in wrong lane

Drives on wrong side of the road

Acts violent or aggressive when driving Drives too slow, or stops, for no reason

Has trouble steering, braking, or otherwise controlling car Is confused by traffic

Gets lost or confused while driving near home

Fails to react to traffic signals, other cars, pedestrians, etc.

Makes turns from wrong lane

Turns in front of on-coming cars

Allows car to drift in and out of lane

Backs up or changes lanes without looking back or

checking mirrors

Applies brake and gas pedals at the same time

Slowreactionsthatmaybecausedbymedicationsordrugs Drives on sidewalk

Makes driving mistakes while talking to passengers

Falls asleep while driving

Other actions (Describe below)

You may use the space below to further describe the driver's condition(s) or action(s) which lead you to believe this driver should be reevaluated by DMV.

Please continue on the next page.

DS 699 (REV. 11/2018) WWW

*DS699*

Relative Friend Caregiver VisionSpecialist Court/Code Other:

Check here if you would like to have your name kept confidential. Confidentiality will be honored to the fullest extent possible. Unsigned reports will not be considered.

NAME (Please print)*

DAYTIME TELEPHONE NUMBER

 

(

)

 

 

 

MAILING ADDRESS (City, State, Zip Code)*

 

 

 

 

 

SIGNATURE*

DATE*

 

X

 

 

 

 

 

YOU MAY MAIL OR TAKE THIS COMPLETED FORM TO YOUR LOCAL DRIVER SAFETY OFFICE AT ONE OF THESE LOCATIONS:

Bakersfield

5800

District Blvd., Ste. 100-B

Sacramento

4700 Broadway, 2nd Flr.

 

Bakersfield, 93313

San Bernardino

Sacramento, 95820-1501

City of Commerce

5801

E. Slauson Ave., Ste. 250

1845 Business Center Dr., Ste 212

 

Commerce, 90040-3050

 

San Bernardino, 92408-3447

City of Orange

790 The City Dr., Ste. 420

San Diego

1455 Frazee Rd., Ste. 400

 

Orange, 92868-4941

 

San Diego, 92108-4378

Covina

1365

N. Grand Ave., Ste. 101

San Francisco

1377 Fell St., 2nd Floor

El Segundo

Covina, 91724-4048

 

San Francisco, 94117-2296

390 N. Pacific Coast Highway, Ste. 2075

San Jose

90 Great Oaks Blvd., Ste. 104

 

El Segundo, 90245-4470

 

San Jose, 95119-1314

Fresno

2510

S. East Ave., Ste. 310

Santa Rosa

2570 Corby Avenue

Oakland

Fresno, 93706-5112

 

Santa Rosa, 95407-6005

7677

Oakport St., Ste. 220

Stockton

710 N. American St.

Oxnard

Oakland, 94621-1906

Van Nuys

Stockton, 95202-1823

2051

N. Solar Dr., Ste. 125

6150 Van Nuys Blvd., Ste. 205

Redding

Oxnard, 93036-2650

 

Van Nuys, 91401-3333

2650

Churn Creek Rd., Ste. 200

 

 

 

Redding, 96002-1169

 

 

DS 699 (REV. 11/2018) WWW

Form Characteristics

Fact Name Description
Purpose The DS 699 form is used to request a reexamination of a driver's ability to operate a vehicle safely.
Confidentiality Individuals can request to remain anonymous when submitting the form. The DMV will honor confidentiality as much as possible.
Submission Locations The completed form can be delivered in person to any DMV office or mailed to the DMV Driver Safety Office.
Required Information Certain fields marked with an asterisk (*) must be filled out for the request to be processed, including the name of the driver, their date of birth, and contact information.
Conditions to Report Reporters should check all relevant boxes regarding the driver's medical or behavioral conditions affecting their driving ability.
Governing Law The use of the DS 699 form is governed by California Vehicle Code Section 138. This law allows reexamination based on safety concerns.

Guidelines on Utilizing Dmv Ds 699

Filling out the DMV DS 699 form is an essential step if you need to report concerns about a driver's ability to operate a vehicle safely. This form allows the Department of Motor Vehicles to assess the situation and take appropriate action. Follow these steps to complete the form correctly:

  1. Open the form and locate the section for the name of the person being reported. Fill in their first name, middle initial (if applicable), and last name in the specified fields.
  2. Enter their date of birth or approximate age in the designated area.
  3. Provide a telephone number where you can be reached.
  4. If known, enter the individual’s driver license number and vehicle license plate number.
  5. Complete their street address, city, state, and ZIP code. Ensure all fields marked with an asterisk (*) are filled out, as they are required.
  6. In the Driver Condition section, check all appropriate boxes to indicate specific medical, physical, or emotional conditions relevant to the individual.
  7. Use the space provided to describe any specific details about the driver's condition, such as the name of any illness or medications being taken.
  8. In the Driver Behavior section, check all boxes for observed driving problems. Add any additional comments in the provided space if necessary.
  9. Include any other relevant details regarding the individual's driving that you believe warrant reevaluation.
  10. Indicate if you would like to keep your name confidential by checking the appropriate box. This can be important if you wish to remain anonymous.
  11. Fill in your own name (printed), daytime telephone number, and mailing address (city, state, ZIP code).
  12. Sign the form where indicated, and enter the date of your signature.
  13. Finally, submit your completed form either by taking it to a DMV office or mailing it to the appropriate Driver Safety Office location.

What You Should Know About This Form

What is the DMV DS 699 form used for?

The DMV DS 699 form is a request for driver reexamination. It allows individuals to formally ask the Department of Motor Vehicles (DMV) to evaluate whether a driver is still capable of operating a vehicle safely.

Who should complete the DS 699 form?

Anyone who has concerns about a driver's ability to drive safely can complete the DS 699 form. This might include friends, family members, caregivers, or professionals who observe problematic driving behavior or medical conditions that may impair driving skills.

Will my identity be kept confidential when I submit the DS 699 form?

Yes, if you check the box requesting confidentiality, your name will not be revealed to the driver being reported. The DMV strives to honor confidentiality to the fullest extent possible.

What information do I need to provide about the driver being reported?

You need to provide the driver’s full name, date of birth or approximate age, telephone number, driver license number, vehicle license plate number (if available), and their address. Additionally, you'll assess their condition and driving behaviors that raise your concerns.

What types of driver conditions can I report on the form?

The form allows you to check boxes for various medical and driving conditions. These include physical or mental health issues, coordination problems, vision impairments, and signs of confusion or drug/alcohol use. You also have space to provide additional details if necessary.

Can I provide detailed information about the driver's behaviors?

Absolutely. The form includes specific boxes for you to describe any concerning behaviors you have observed while the driver was operating a vehicle. You can write comments about actions like driving too slowly, failing to react to traffic signals, or dangerous maneuvers.

How do I submit the DS 699 form?

You can either mail the completed form or deliver it in person to your local DMV Driver Safety Office. The addresses for various locations are provided on the form, ensuring you can find the nearest office.

Is there a deadline for submitting the DS 699 form?

There is no specific deadline mentioned for submitting the form. However, it’s advisable to submit it as soon as possible after you observe concerning behavior. Prompt action may be necessary for the safety of the driver and others on the road.

What happens after I submit the DS 699 form?

Once submitted, the DMV will review the information provided. They may decide to contact the reported driver for a reexamination of their driving abilities. Based on the results, the DMV could take various actions, which may include reissuing the driver's license or imposing restrictions.

Common mistakes

When filling out the DMV DS 699 form, many people make avoidable mistakes that can delay the reevaluation process or cause their requests to be rejected. Understanding these common errors can help ensure that your submission is complete and accurate.

One frequent mistake is failing to sign the form. The signature is essential and verifies that the information provided is accurate. An unsigned form will not be considered, meaning that the request for reevaluation will go unprocessed. Double-checking this requirement before submission can save time.

Another error involves skipping required fields. The form has several fields marked with an asterisk (*) to indicate that these pieces of information are mandatory. Leaving any of these blank may lead to automatic rejection of the request. It's important to make sure that you complete all required sections, which include the name of the person being reported, their date of birth or approximate age, and contact details.

Confusion about the driver's condition is also common. Many individuals do not provide sufficient details about the driver's medical or behavioral issues. The form asks for specific descriptions, such as names of diseases or medications. Providing vague information can weaken the case, so taking time to be as descriptive as possible is crucial.

People frequently misjudge the importance of documenting observed driving behaviors. The section asking for descriptions of driving problems should not be ignored. Simply checking a box is not enough. Specific examples and circumstances help the DMV understand the concerns better. Avoiding general statements in favor of detailed observations will enhance the request.

Another mistake is not indicating confidentiality preferences. If you wish to keep your name confidential, it's essential to check the box for confidentiality on the form. Neglecting this step means the DMV cannot guarantee that your identity will be protected, which may dissuade some from making a report.

Lastly, people often forget to include a current daytime phone number or mailing address. This information is crucial for the DMV to contact you regarding your request or to provide updates on the reevaluation process. If this information is missing, it could lead to further delays.

By being mindful of these common mistakes, individuals can efficiently complete the DMV DS 699 form and ensure that their concerns about a driver's safety are properly evaluated.

Documents used along the form

The DMV DS 699 form is an essential document for anyone concerned about a driver's ability to operate a vehicle safely. However, there are several other forms and documents that often accompany this request. These documents can provide additional context or information needed for the reexamination process. Here's a brief overview of some related documents:

  • DMV Driver's Medical Evaluation Form: This form collects detailed medical information regarding a driver's physical or mental health that might affect their ability to drive. It helps ensure that the DMV can assess any medical conditions effectively.
  • DMV Vision Testing Report: Often required, this report confirms that the driver has passed the necessary vision tests. It helps to ensure that the driver meets the state's vision standards to operate a vehicle safely.
  • Patient Medical Report: A report from a physician detailing a driver's medical history and current health status can be crucial. This document helps the DMV understand any medical issues that might impact driving ability.
  • Statement of Witness: A statement from individuals who have observed the driver's behavior can provide valuable insights. This document can corroborate claims made in the DS 699 form about unsafe driving practices.
  • Driving School Evaluation: If the driver has recently attended a driving school, an evaluation report may be submitted. This document can highlight the individual's strengths and weaknesses behind the wheel.
  • Driver’s License History: A record of the individual's driving history, including previous violations or incidents, may be requested. This document helps provide a comprehensive view of the driver's behavior over time.
  • Incident Report: If there have been specific incidents involving the driver that raised concern, an incident report may be necessary. It details any accidents or dangerous driving behaviors observed.
  • Road Test Scheduling Form: If a reexamination is required, this form is used to schedule a road test. It helps facilitate the process of reassessing the driver's abilities in a practical setting.

These documents, among others, can support a comprehensive evaluation process. Providing accurate and complete information will help ensure a fair assessment of driving abilities.

Similar forms

  • DMV Form DS 1: This form addresses the application for a driver's license. Like the DS 699, it requires personal information to verify the driver's identity and assess their eligibility to drive safely.

  • DMV Form DS 323: This form is used for reporting a driver’s medical condition. Similar to DS 699, it involves providing details about an individual's health that may impair their ability to drive.

  • DMV Form DS 506: This document initiates a restricted driver's license request. It parallels the DS 699 by requiring a rationale for the restrictions based on the driver’s capabilities.

  • DMV Form DL 44: This form is for driver's license applications or renewals. Both forms help evaluate if the applicant meets necessary criteria related to safety and fitness to drive.

  • DMV Form INF 70: This is a request for information about driving records. It shares similarities with the DS 699 by enabling individuals to assess a driver's competency and history.

  • DMV Form DS 250: Used for filing a complaint against a driver. Like DS 699, it solicits observations regarding driving behavior to support an evaluation of driving abilities.

  • DMV Form DL 65: This form is designed for reporting a change in health status. It is similar to the DS 699 in that it requires details about medical conditions that could impact driving skills.

  • DMV Form DS 425: This form applies to seniors who wish to renew their licenses. It parallels the DS 699 by focusing on safety concerns that could necessitate additional scrutiny of a driver’s capabilities.

Dos and Don'ts

When filling out the DMV DS 699 form, it is crucial to be mindful of certain practices to ensure that your submission is effective and complete. Below is a summary of recommended actions and common mistakes to avoid:

  • Do provide all required information. Fill in every field marked with an asterisk (*), as incomplete forms may lead to delays or rejection.
  • Do sign the form. Remember that unsigned forms will not be considered, so make sure to write your signature in the designated area.
  • Do maintain confidentiality. If you expect your identity to remain private, check the box indicating you would like that your name not be revealed.
  • Do provide specific details. When describing the driver’s condition or behavior, include concrete examples to give the DMV a clearer understanding of your concerns.
  • Don't rush your submission. Take your time to review the form for errors and ensure all necessary details are included before turning it in.
  • Don't be vague in your descriptions. Avoid general statements; instead, elaborate on the specific signs or behaviors that prompted your concern to facilitate a thorough investigation.

By following these guidelines, you can better ensure that your concerns are effectively communicated and that the process runs smoothly.

Misconceptions

Here are six common misconceptions about the DMV DS 699 form:

  • Confidentiality is not guaranteed. Many believe that their report will automatically be shared. However, the DMV honors requests for confidentiality to the fullest extent possible.
  • You need to be a licensed driver to file a report. Some think only individuals with a driver’s license can submit the form. In reality, friends, family, or caregivers can report concerns about a driver’s ability to operate a vehicle safely.
  • Only medical conditions are relevant. It's a misconception that only medical issues merit a reexamination. Any behavior or driving problems observed can justify a request for a reevaluation.
  • The form can be submitted anonymously without consequences. While anonymity is allowed, it’s important to note that unsigned reports will not be considered by the DMV.
  • Filing a report leads to immediate consequences for the driver. Some might think that a report guarantees immediate action. The DMV conducts a thorough assessment before determining any further steps.
  • All fields of the form are optional. It is commonly believed that every section is optional. However, all fields marked with an asterisk are required for the report to be processed.

Key takeaways

Filling out and using the DMV DS 699 form involves several key points to ensure a smooth process. Here are nine important takeaways:

  • Purpose of the Form: This form is used to request the DMV to reexamine a driver's ability to drive safely.
  • Confidentiality Option: You can request confidentiality for yourself. Your name will not be revealed to the individual being reported.
  • Required Fields: Pay attention to fields marked with an asterisk (*); they must be filled out for the form to be accepted.
  • Signature Needed: Make sure to sign the request. Unsigned forms will be disregarded.
  • Submission Methods: You can submit the completed form in person at a DMV office or mail it to the Driver Safety Office.
  • Provide Specific Details: Include specific details about the driver’s medical conditions or behaviors that prompted your request.
  • Behavior Observations: Check all applicable boxes regarding observed driving issues. Thorough documentation will aid your request.
  • Use Additional Space: If needed, utilize the provided space to describe further any concerns you have regarding the driver.
  • Keep Copies: Always keep a copy of the completed form for your personal records after submission.

Understanding these points will help in effectively using the DMV DS 699 form to address any concerns about a driver's safety on the road.