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Illness or Functional Impairment Checklist

If one of the following health issues applies to you, we recommend that you call the Société de l’assurance automobile du Québec before registering for a driving course. You may have to undergo a medical or eye examination before being eligible to obtain a driver’s licence.

I have an eye disease or disorder (cataracts, glaucoma, retinopathy, macular degeneration, double vision, loss of an eye or no vision in one eye, etc.).
No
Yes
I have bilateral hearing loss with or without a hearing aid.
No
Yes
I have a heart condition (infarction, angina, palpitations, defibrillator, transplant, etc.) that restricts activities such as walking.
No
Yes
I experience excessive sleepiness related to a sleep disorder (sleep apnea, narcolepsy, etc.).
No
Yes
I have had significantly limited mobility for several months in my neck, hands or feet (amputation, permanent immobility, polyarthritis, etc.).
No
Yes
I have a serious behavioural problem or psychiatric disorder (schizophrenia, bipolar disorder, recurrent major depression, etc.).
No
Yes
I have a substance use disorder (alcohol, drugs or other substances).
No
Yes
I have a cognitive impairment (dementia, Alzheimer’s disease, psychomotor retardation, cognitive impairment, etc.).
No
Yes
I have had epileptic seizures.
No
Yes
I have a neurological condition (stroke, head trauma, paralysis, Parkinson’s disease, multiple sclerosis, autism spectrum disorder, etc.).
No
Yes
I have experienced loss of consciousness, syncopes or non-epileptic convulsions in the past 12 months.
No
Yes
I have insulin-treated diabetes.
No
Yes
I have a lung disease (emphysema, chronic bronchitis, any condition requiring the use of oxygen, etc.) that restricts activities such as walking.
No
Yes
I need home assistance to carry out daily activities (eating, hygiene, dressing, moving about, etc.).
No
Yes
I take medication that causes daytime drowsiness (sleeping pills, anti-anxiety medication, painkillers, etc.).
No
Yes
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