Application for Waiver of Ignition Interlock Participation Fee (Form #DC-212) This form is to waive the $47 enrollment fee for all participants who provide documentation that they are on medical or food assistance.
Treatment Provider's Report(Form #DC-118) This form is to be completed by your treatment provider (hospital, alcohol or drug clinic) and is used as an aid in determining your qualifications to drive.
Physician/Health Care Provider Report (Form #DC-119) This form is to be completed by your physician/health care provider and is used as an aid in determining the qualifications of an individual to drive.
Health Questionnaire (Form #DC-001) This form is used to provide a comprehensive medical history regarding your medical status as it related to driving.
Alcohol & Drug Use Questionnaire (Form #DC-001A) This form is used to provide a detailed alcohol/drug use history.
Physician Referral (Form #DC-220) This form is to be completed by a physician/health care provider to report concerns about medical fitness to drive.
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