DVLA D4 Driver Medical Request Form

Appointment type

In-person appointment

In-person appointment in Cambridge (CB24 8TX)

D4 medical in Cambridge£44.99

Home visit

Please select the band that best matches your location

Home visit up to 10 miles from CB24 8TX£55

Home visit 11-25 miles from CB24 8TX£65

Home visit 26-50 miles from CB24 8TX£75

Home visit 51-75 miles from CB24 8TX£85

Home visit 76-100 miles from CB24 8TX£95

Personal details

Full Name

Date of Birth

Day

Month

Year

Email

Home Address

Postcode

Telephone Number

License details

Type of licence

Is this your first Group 2 medical?

Medical screening

Are you aware of any medical condition that may affect DVLA fitness to drive?

Medical condition

Add anything you feel we should be aware of or any questions you have

Preferred Date and Time

For SAME DAY or NEXT DAY appointments

please message or call us (Directly or via WhatsApp)

07802782563

Preferred Date and Time

Subject to availability. We will contact you shortly after your submission to confirm.

Please bring your GP medical records on the day of your D4 medical.

This can be via the

NHS App (GP Health Record) or
A printed GP medical summary from your surgery.

Tip: If you do not currently have access via the NHS App, contact your GP surgery reception a few days in advance to request a medical summary.

Do you already have a DVLA D4 form?

Yes, I will bring it

You can download the D4 form from the DVLA website, or we can provide it.

Do you have your GP records printed or in the NHS App?

I have printed GP Records

I have GP records on NHS App

I confirm the information provided is accurate to the best of my knowledge

I understand this is a private medical service

I understand home-visit pricing is based on distance band from CB24 8TX

I understand DVLA acceptance is subject to their own criteria

I confirm that I have read and understood the Clarity Medicine Terms of Service, Disclaimer, and Privacy Policy, and I agree to proceed on this basis.

Electronic Signature

Date

Day

Month

Year

Clarity Medicine

GMC-registered doctor-led services

DVLA D4 Driver Medical Request Form

Appointment type

Personal details

License details

Medical screening

Preferred Date and Time

For SAME DAY or NEXT DAY appointments

please message or call us (Directly or via WhatsApp)

07802782563