Aviation Medical Examination Registration Form

This registration form is specifically designed for Aviation Medical Examiners conducting Federal Aviation Administration (FAA) medical certification examinations for pilots, air traffic controllers, and other aviation personnel. The form streamlines the collection of information required for first, second, or third class medical certificate applications, ensuring compliance with FAA regulations and MedXPress system requirements. It captures essential pilot demographics, certificate class being sought, and aviation-specific medical history relevant to flight safety determinations.

The form includes sections for current pilot certificate information, flight hours, type ratings, and previous medical certificate history. It collects detailed information about medical conditions that could affect flight safety, including cardiovascular issues, neurological conditions, mental health history, substance use, and medications that may be disqualifying or require special issuance authorization. The registration also captures information needed for age-specific requirements, such as EKG documentation for pilots over 35 seeking first class certification. This comprehensive intake ensures AMEs have all necessary information to conduct thorough examinations and make appropriate certification recommendations to the FAA.