Driving a heavy goods vehicle (HGV) comes with a huge responsibility. You’re handling large, powerful machinery on busy roads, often for long hours, and your health directly impacts not just your safety, but the safety of everyone around you. That’s why all UK HGV drivers must pass a D4 medical test before getting behind the wheel and keep passing them throughout their career.
Whether you’re applying for your first HGV licence or it’s time for your renewal, this guide explains what the HGV medical test involves, how to prepare, how often you’ll need one, and what happens if things don’t go to plan.
This guide was last updated in October 2025.
At a glance, the essentials:
A UK HGV D4 medical test uses the DVLA D4 medical report and is required for anyone applying for, or holding, a Group 2 (bus, coach or lorry) entitlement.
The D4 examines vision, blood pressure and general health, and asks about specific conditions such as diabetes, epilepsy and sleep apnoea.
You must tell the DVLA about any medical condition that might affect safe driving, or risk a fine, licence suspension or prosecution.
Who needs an HGV D4 medical test?
You need a Group 2 medical (the D4) if you are:
Applying for your first provisional entitlement to drive large goods vehicles, or
Applying for the full Group 2 licence, or
Renewing a Group 2 entitlement when required by DVLA rules.
In short, any UK HGV driver either starting the licence process or renewing at the required intervals must complete the D4 medical.
Remember, as an HGV driver, you're handling large, powerful machinery on busy roads, often for long hours, and your health directly impacts not just your safety, but the safety of everyone around you.
What is an HGV D4 medical test, and why is it important?
An HGV medical test is an official health assessment to make sure you’re fit to operate a heavy goods vehicle (HGV) safely.
It’s a legal requirement set by the Driver and Vehicle Licensing Agency (DVLA), and it’s there to protect:
You: spotting medical issues early helps keep you healthy and working.
Other road users: ensuring drivers can respond quickly and safely in all conditions.
Your employer and livelihood: a valid medical is essential to keep your HGV licence.
Failing to keep your medical certificate up to date can lead to fines, penalties, and the loss of your licence. You can read more about the rules in our HGV driver regulations guide.
What does a UK HGV D4 medical test involve?
The UK HGV medical usually takes around 30 minutes and is carried out by a doctor. It covers a range of health checks to make sure you meet DVLA medical standards.
Here’s what’s typically included:
Medical history review: You’ll be asked about past and current health conditions, medications, and hospital visits.
Eyesight test: To check you meet the required vision standard, with or without glasses/contact lenses.
Hearing test: Ensuring you can hear traffic noise and warning signals clearly.
Blood pressure check: High blood pressure can increase accident risk.
General fitness assessment: Evaluating your physical ability to handle the demands of HGV driving.
Urine test: Screening for diabetes or other underlying health conditions.
Drug & alcohol check: It’s illegal to operate an HGV under the influence. The doctor will look for any signs of misuse.
Steps for drivers: how to prepare for your D4 medical
The more prepared you are, the smoother the process will be.
Book the D4 with an authorised clinician, GP surgery or accredited provider. Ask if they will post the completed form to DVLA on your behalf.
Bring identification, your current driving licence, any glasses or contact lens prescriptions, a list of current medication and, if appropriate, recent test results (blood pressure logs, HbA1c, sleep clinic reports).
If you take readings at home, bring a printout or photos showing recent blood pressure or glucose readings; these can help if the clinician suspects spikes.
If you have been diagnosed with sleep apnoea or are on CPAP, bring clinic letters confirming diagnosis and compliance.
If you are starting a new medication that may affect alertness, speak to your clinician about timing the medical appointment or arranging extra monitoring.
Bring the following:
D4 medical form (downloadable from the DVLA website).
Your driving licence or passport.
Glasses/contact lenses (plus a recent prescription).
A list of your current medications (with dosages and start dates).
Any relevant hospital letters or discharge notes.
Do the following before your appointment:
Get a good night’s sleep to be alert and relaxed.
Avoid excessive caffeine, which can raise blood pressure.
Wear comfortable clothing for physical tests.
How often and when do HGV drivers need a D4 medical check?
Rules can vary by age and circumstances, but the usual pattern is:
New applicants complete a D4 as part of their licence application.
Under 45: Medical valid until your 45th birthday.
45 to 65: Every 5 years.
Over 65: Every year.
If you develop a medical condition that could affect your driving between checks, you must inform the DVLA immediately. Not reporting changes can lead to serious penalties.
The DVLA may issue shorter licences for drivers with specific medical issues. If in doubt, check the DVLA guidance or speak to an occupational health provider.
The D4 medical: what the examiner checks
The D4 medical is a formal report completed by an authorised clinician. The form itself and the accompanying guidance explain exactly what is required.
Key checks include:
Vision
Drivers must meet the Group 2 eyesight standard. In practice, that means being able to read a number plate at 20 metres in good light, with any corrective lenses in use, and meeting the required visual acuity level. If the clinician cannot fully test vision, an optician or optometrist must complete the eyesight section.
Blood pressure
Blood pressure is measured at the appointment. For Group 2 entitlement, DVLA treats a consistently raised reading of 180/100 mmHg or more as a trigger to stop driving and notify the DVLA. Readings below that threshold still require medical judgment, but most drivers with controlled blood pressure pass.
Diabetes and glucose control
Diabetes is carefully assessed. Drivers starting insulin treatment or who have had severe hypoglycaemia must stop driving and notify DVLA. The D4 and follow-up processes differ depending on insulin use, oral medication and complications such as diabetic eye disease. Group 2 drivers face stricter rules than car drivers.
Sleep and excessive daytime sleepiness
Conditions that cause excessive sleepiness, notably obstructive sleep apnoea, must be declared. Moderate or severe obstructive sleep apnoea with excessive sleepiness requires treatment and medical confirmation before driving resumes. Mild cases without sleepiness may not require notification, but the rules are specific and must be followed.
Neurology, seizures and epilepsy
Any history of seizures is treated seriously. The DVLA has defined seizure-free periods and reporting rules for different seizure types. Group 2 drivers often face longer disqualification or monitoring periods than car drivers. Specialist reports and ongoing review are commonly required.
Mental health, substance use and other conditions
The D4 asks about significant psychiatric conditions, alcohol or drug misuse, stroke, cardiac events and many other health issues. The DVLA guidance sets out which conditions are notifiable and the medical evidence required.
Additional checks
Clinics may also check height and weight, review medication lists, and some providers screen urine for glucose or other markers where clinically appropriate. The D4 guidance explains what the examining clinician needs to record. Practices vary between clinics.
What happens after the D4 medical
If you meet the standards, the clinician completes the D4, and you submit it with your licence application or renewal.
If a condition needs further investigation, DVLA may ask for extra evidence, impose limits on the licence, or issue a shorter licence requiring earlier review.
If you fail to notify a notifiable medical condition and keep driving, you risk a fine of up to £1,000, licence revocation and possible prosecution if an accident occurs. Always tell DVLA promptly.
HGV medical requirements: what might cause a driver to fail their D4?
Some conditions can prevent you from passing, including:
Poor eyesight or hearing loss.
High blood pressure.
Diabetes that is not properly managed.
Sleep apnoea (if untreated).
Epilepsy.
Serious heart conditions.
Recent blackouts or fainting episodes.
Ongoing drug or alcohol misuse.
The standards are strict because the risks are high: an unfit driver in control of a 44-tonne vehicle can cause catastrophic harm.
If you’re concerned, speak to your GP before booking your medical.
What to do if you fail the D4 HGV medical
Failing doesn’t always mean the end of your career.
Here’s the typical process:
Talk to your doctor - Find out exactly why you failed and whether the condition can be treated or managed.
Address the issue - Follow medical advice, treatment plans, or lifestyle changes.
Reapply - Once your condition is under control, submit a new D4 form with your application to the DVLA.
Wait for DVLA review - They’ll assess your case, which can take weeks or months depending on complexity.
Meet any extra requirements - You may need additional tests or monitoring before your licence is reinstated.
What employers and fleet managers should do
Build medical checks into recruitment and renewal workflows. Require a completed D4 for new drivers and retain proof of current entitlement.
Educate drivers about their legal duty to inform DVLA of medical changes and the consequences of not doing so.
Offer occupational health support and an environment that encourages drivers to report symptoms early, especially for sleep problems, diabetes control or cardiac symptoms.
Keep records of medical expiry dates and set reminders for renewals. Many businesses use their HR or fleet system to automate alerts.
Consider providing access to an occupational health provider or D4 clinic to speed up assessments and limit downtime.
HGV D4 medical FAQs
Do I have to tell my employer about my medical condition?
You must tell DVLA about notifiable conditions. Employers should ask about fitness for work where relevant, and employees should be encouraged to report issues that affect safety. Legal obligations and privacy rules both apply, so handle disclosures through HR or occupational health.
Will I be tested for drugs or alcohol during a D4?
A routine D4 usually does not include drug testing. However, if the clinician has concerns about substance misuse, they may recommend further testing or referral. Separate employer drug and alcohol policies can require workplace testing.
How long does a D4 appointment take?
Most D4 exams take about 20 to 40 minutes. If extra tests or specialist reports are needed, the overall process will take longer.
Who conducts the HGV medical check?
A doctor: either your GP or a private medical examiner approved for DVLA checks.
Do you need a medical to renew your HGV licence?
Yes: at the intervals above, and sooner if your health changes.
How much does the D4 medical test cost?
Private HGV medicals typically cost £50–£120, depending on the provider.
What should you do if you develop a medical condition?
Report it to the DVLA right away. Early disclosure avoids bigger problems later.
What if I fail the D4?
Failing the D4 does not always mean a permanent ban. Often you will be referred for further investigations, treatment or monitoring. Once the condition is controlled, you can submit supporting medical evidence for relicensing.
Our checklist: what to bring to your D4 appointment
Current driving licence and a second ID.
Glasses and prescription if you wear them for driving.
Up-to-date list of medications and any clinic letters.
Recent home blood pressure or glucose readings, if available.
Sleep clinic reports or CPAP compliance data, if relevant.
Our final, practical advice
Plan ahead. Book your D4 well before your licence or entitlement expires. Keep records of medical letters, blood pressure and glucose readings, and any clinic correspondence. If a condition develops, notify DVLA promptly and seek medical advice. Staying proactive protects your licence, your safety and the safety of other road users.
The bottom line
Your D4 HGV medical isn’t just a box-ticking exercise: it’s a crucial part of keeping you, your load, and everyone else on the road safe. Staying proactive about your health also keeps your licence secure and your career moving.
For more tips on staying safe and compliant, check out our guides on HGV walk-around checks, top safety tips for HGV drivers, and essential items for every HGV.
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