Form Ds-7 - Request For Driver Review
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1
2REQUEST FOR DRIVER REVIEW
dmv.ny.gov
INSTRUCTIONS:
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This form is to be used by concerned citizens to report a driver who appears to be unable to drive safely. (Law enforcement personnel must
use form DS-5, “Police Agency Request for Driver Review”; physicians must use form DS-6, “Physician’s Reporting Form”).
The Department will not act on your request unless you complete all four parts below and on Page 2, and provide all required information.
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Please provide as much factual detail as possible.
Sign the completed original form and mail it to:
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Medical Review Unit
New York State Department of Motor Vehicles
6 Empire State Plaza, Room 337
Albany, NY 12228
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Be aware that the review you are requesting may lead to the suspension or revocation of the driver’s license of the person you are reporting.
PART 1 - Identification of the person whose ability to drive is in question (Please print.)
Last Name (Required)
First Name (Required)
M.I.
Date of Birth (if not known, give approximate age) -
(Required)
Street Address (Required)
City (Required)
State (Required)
Zip Code
Make of Vehicle the
Color of
License Plate
Person Normally Drives
Vehicle
Number
PART 2 - Your identification (Please print.)
A representative of the NYS DMV may contact you concerning your request for driver review.
Your Name (Print name in full) - (Required)
Your Date of Birth (Required)
Client ID No. (9-digit number from your NYS Driver License or
Non-Driver ID card)
Your Home Address (Include Street & Number) - (Required)
City (Required)
State (Required) Zip Code (Required)
Your Daytime Telephone Number (Area Code) - (Required)
Your relationship to the driver you are reporting:
o
o
o
o
o
o
o
o
Daughter
Son
Sister
Brother
Spouse
Mother
Father
Neighbor
o
Other (explain)
PART 3 - Your reasons for reporting this driver
Explain why you feel the person you identified in Part 1 should have his/her driving abilities reviewed. Be as specific as possible, and include
specific incidents, observations, dates, locations, etc.
(Part 3 is continued on Page 2)
PAGE 1 OF 2
DS-7 (6/15)
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