25cc2599_Affairs_Forms_and_Publications__Description
[Form] Medical Evaluation Form [Instructions] Print your full name and License or Social Security number in the appropriate space. Please sign and date the form. Have your physician complete the questions concerning your medical history. [Description] 
This form is to be completed by your physician when the Registry has a question concerning your medical/physical qualification for driving. Additionally, this form may be used to regain your driving privilege after the voluntary surrender of your license. PLEASE NOTE: If your license is in revoked or suspended status, then your doctor may need to review documentation including a police report if the suspension is a result of an incident reported to the RMV by law enforcement. If your license is revoked or suspended, then you must see a Hearings Officer.
Massachusetts RMV - Medical Affairs Forms and Publications
Description