Aviation Medical Examination Billing Form

This aviation medical examination billing form is tailored for Aviation Medical Examiners (AMEs) who conduct Federal Aviation Administration medical certifications for pilots and air traffic controllers. Since FAA medical examinations are typically not covered by health insurance, this form streamlines self-pay billing for Class 1, Class 2, and Class 3 medical certificates. It captures exam class selection, additional testing fees, EKG charges, and special issuance consultation costs that vary by certification requirements and pilot age.

The template includes sections for medical certificate class designation, vision and hearing testing fees, cardiovascular screening charges, and expedited processing options. It provides clear fee breakdowns for first-class airline transport pilot medicals, second-class commercial pilot exams, and third-class private pilot certifications. The form accommodates additional charges for deferred certification consultations, special issuance documentation, and age-based testing requirements. Perfect for AME offices, aerospace medicine clinics, and flight surgeons managing non-insurance medical billing.