The Complete D4 Medical Guide

Everything professional drivers need to know about the DVLA Group 2 driving medical — explained clearly by Dr. Zain Abideen.

What Is a D4 Medical?

A D4 medical examination is the official DVLA medical assessment required for Group 2 driving licences. Group 2 covers large lorries (HGV/Category C) and buses and coaches (PCV/Category D), as well as taxis in many areas.

The examination must be carried out by a GMC-registered doctor and recorded on the official D4 form. This form is then submitted to the DVLA as part of your licence application or renewal.

The examination typically takes 15–20 minutes and covers vision, blood pressure, BMI, and a thorough review of your medical history.

Medical examination

D4 Medical Renewal Schedule

The DVLA requires a D4 at specific points in your driving career.

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First Application

When applying for your first provisional HGV or PCV licence. A D4 submitted within the last 12 months is accepted.

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At Age 45

The first age-related medical is required when renewing your Group 2 entitlement at age 45.

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45–65: Every 5 Years

Between the ages of 45 and 65, a D4 is required every five years at each licence renewal.

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65+: Every Year

From age 65 onwards, a D4 medical is required every single year to maintain your Group 2 entitlement.

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DVLA Request

The DVLA can request a medical at any time if they have concerns about your fitness to drive, regardless of your age.

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70 & C1/D1

Drivers aged 70+ who still need C1 or D1 entitlement require a D4 every 3 years.

What Does the D4 Examination Cover?

The examination is thorough but typically completed in 15–20 minutes.

Vision (acuity and visual field)
Blood pressure measurement
Body mass index (BMI)
Cardiovascular system review
Neurological history and assessment
Diabetes status and monitoring
Mental health history
Sleep disorders (incl. sleep apnoea)
Renal and respiratory conditions
Drug or alcohol history
Current medication review
General physical examination

How Medical Conditions Affect Your D4

Not all conditions automatically disqualify you. Here's what drivers most commonly ask about.

Diabetes (Insulin-Treated)
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Insulin-treated diabetic drivers can hold a Group 2 licence if strict monitoring requirements are met. You must use a blood glucose meter with at least 3 months of stored readings and test regularly as per DVLA regulations. Continuous glucose monitors alone are not sufficient — blood glucose monitoring is required. Bring your meter and readings to the appointment.
Heart Conditions (Ischaemic Heart Disease)
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Drivers with evidence of ischaemic heart disease must provide a satisfactory exercise tolerance test (treadmill test) no more than 3 years old. This must meet specific DVLA criteria. If you're unsure whether your test is current or adequate, speak to your GP. Note that tests purely for licensing purposes are not funded by the NHS.
Sleep Apnoea
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Drivers with moderate to severe obstructive sleep apnoea must be effectively treated (typically with CPAP) and provide a copy of their most recent specialist clinic review within the last year. Well-managed sleep apnoea does not automatically disqualify you from holding a Group 2 licence.
High Blood Pressure
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There are specific DVLA thresholds for blood pressure in Group 2 drivers. Avoid caffeine and smoking for at least an hour before your appointment to ensure an accurate reading. If your BP is borderline, a second reading may be taken. Controlled hypertension on medication is generally acceptable.
Epilepsy
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Epilepsy standards for Group 2 licences are more stringent than Group 1. Generally, drivers must be seizure-free for 10 years without anti-epileptic medication to hold a Group 2 licence. There are complex exceptions — speak to us or the DVLA directly if this applies to you.
Vision Problems
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Group 2 drivers must meet specific vision standards: visual acuity of at least 6/7.5 in the better eye and 6/60 in the worse eye (corrected), and an adequate field of vision. Bring your glasses or contact lenses. If you've had eye surgery, bring documentation from your specialist.
Mental Health Conditions
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A history of mental health conditions does not automatically disqualify you. The DVLA assesses each case individually. Drivers who are stable, well-managed and not impaired by their condition or medication can often continue to drive. Be open and honest during your assessment.

What to Bring on the Day

Photo ID (driving licence or passport)
Current medication list
Glasses or contact lenses (if worn)
Blank D4 form (if you have one)
Previous medical forms if available
Blood glucose meter (diabetic drivers)
Exercise tolerance test results (cardiac)
Sleep clinic review letter (if applicable)
Pro tip: Avoid caffeine and smoking for at least one hour before your appointment. This helps ensure an accurate blood pressure reading and avoids a repeat appointment.

Have Questions? We're Here to Help.

Not sure if you need a D4 or what to bring? Call us — free advice, no obligation.