This application is a two page form. The applicant is required to complete the first page of the form and the second page of the form MUST be completed by a Massachusetts healthcare provider. The form contains a list of the types of healthcare providers eligible to complete the form. Once you complete the first page, you should take both pages of the form to your healthcare provider to complete the second page. Please return both completed pages to the RMV for processing. The completed form can either be mailed to Medical Affairs or submitted to any RMV Service Center.
Healthcare professionals: Read more about the revised application form in effect as of January 2017.
For more information, visit our Disabled Veterans Plate page.
The VA letter MUST provide a rating breakdown of the service connected impairment(s).