Medical Forms
Release of Records
new patient forms
basicmed flight physical
A Basic Med physical will substitute for a FAA Medical Certificate and allows pilots to operate authorized aircraft having a maximum certified takeoff weight of 6000 pounds or less, 6 or less occupants (including the pilot) at altitudes up to 18,000 feet, not exceeding 250 knots, and not for hire.
In order to qualify you must possess a U.S. driver's license and have had an FAA medical certificate after July 14, 2006.
There are certain disqualifications for a BasicMed physical. If you have any of these you will need a flight physical and clearance from a FAA certified medical flight examiner. The disqualifications are as follows:
1. A personality disorder such as a psychosis with delusions or hallucinations, bipolar disorder, or a substance dependence within the previous 2 years.
2. A neurological disorder causing loss of consciousness such as a seizure disorder or other loss of consciousness without a satisfactory explanation.
3. One of the 4 listed cardiac conditions.
A. Previous myocardial infarction
B. Coronary heart disease that has required treatment
C. Cardiac valve replacement
D. Heart replacement
To fly under BasicMed rules, you will need to take a BasicMed online medical course every 2 years and get a BasicMed physical every 4 years. The BasicMed online medical course is free and typically takes 1½ hours to complete. It can be accessed from either of these locations:
If you set up a BasicMed physical with us, please print and complete the Comprehensive Medical Examination Checklist and bring to your appointment.
Sports Physical Exam Form
dot medical examination form
vaccine information
DTaP (Diphtheria/Tetanus/Pertussis) Vaccine Pneumococcal Conjugate Vaccine
TDaP (Tetanus/Diphtheria/Pertussis) Vaccine Pneumococcal Polysaccharide Vaccine
Hepatitis A Vaccine Polio Vaccine
Hepatitis B Vaccine Recombinant Zoster (Shingles) Vaccine
Hib Vaccine Rotavirus Vaccine
HPV (Human Papiloma Virus) Vaccine Serogroup B Meningococcal Vaccine
Influenza (Flu) Vaccine Td Vaccine
Meningococcal ACWY Vaccine Varicella (Chickenpox) Vaccine
MMR (Measles/Mumps/Rubella) Vaccine
TDaP (Tetanus/Diphtheria/Pertussis) Vaccine Pneumococcal Polysaccharide Vaccine
Hepatitis A Vaccine Polio Vaccine
Hepatitis B Vaccine Recombinant Zoster (Shingles) Vaccine
Hib Vaccine Rotavirus Vaccine
HPV (Human Papiloma Virus) Vaccine Serogroup B Meningococcal Vaccine
Influenza (Flu) Vaccine Td Vaccine
Meningococcal ACWY Vaccine Varicella (Chickenpox) Vaccine
MMR (Measles/Mumps/Rubella) Vaccine