Provider Notes
New Hampshire · Help

Already have a signed form? Here is where it goes

A NH DMV office, its drop box (with a copy of your license), or by mail to NH DMV, Walking Disability Section, 23 Hazen Drive, Concord, NH 03305. The placard is see NH DMV for the current fee.

What to bring

  1. The signed original RDMV 130. The DMV accepts the original signature only, not a copy or a stamp.
  2. Your New Hampshire driver license or ID card, or proof of residency.
  3. If you are doing this for someone else, ask NH DMV what they need from you.

Without a visit

The original can be mailed.

Do not have the form yet?

It is free from New Hampshire Division of Motor Vehicles. Your own doctor can complete the medical part.

Mistakes that cause a second trip

  • A copy, scan or fax instead of the original.
  • A stamped signature.
  • The doctor’s written description of the condition and outlook left blank.

No doctor who will complete it? A New Hampshire-licensed doctor can evaluate you online. Start a free check ›

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