ARIZONA MVD MEDICAL REVIEW
Report an Unsafe Driver in Arizona (Form 96-0469)
Turn direct safety observations into a complete Arizona MVD Medical Review report.
What is Form 96-0469 used for?
Use this guided walkthrough when you have direct knowledge of a licensed Arizona driver's condition or behavior that may affect safe driving. Docgle helps you identify the driver, select the concern categories, and write the facts MVD needs to review.
Give Arizona MVD enough direct, specific information to decide whether medical review or testing may be needed.
Do not guess. AZDOT says the report must be based on direct knowledge and incomplete reports will not be accepted.
Time, difficulty & who this form is for
Average time
10-15 minutes
Difficulty
moderate
Best for
People with firsthand observations about a driver's medical, visual, mental, emotional, or unsafe-driving concern
What do I need before I start?
- Driver name, date of birth, address, and license information if known
- Specific incidents, dates, places, accidents, or conditions you directly observed
- Your name, address, phone number, and signing date
How the walkthrough is organized
Confirm direct knowledge
Make sure you can report specific facts rather than rumors.
Identify the driver
Collect the driver name, birth date, license details, and address.
Choose concern categories
Select every printed condition or behavior category that fits your observations.
Describe what happened
Write the dates, places, incidents, conditions, and other facts MVD should review.
Sign and submit
Add your contact information, review the report, print it, and sign it.
What happens after I complete it?
Answer the questions, review your document, then follow its official signing and delivery instructions. Downloading does not submit the form.
Start arizona-driver-condition-behavior-report-96-0469 walkthrough