Medical Certification Forms

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Forms required for Medical Certification

Form Title
24067-001 (PDF 162 KB) Application for Medical Certificate
Online Payment for Medical Certification
Frequently Asked Questions
24067-407 Application for Replacement of a Medical Certificate
24067-002 (PDF)  Medical Examination Report
24067-003 (PDF) Medical Assessment Report

Forms providing or requesting supporting information

Form Title
24067-211 Special Eye Report (including advice on completion of the form)
24067-106 (PDF) Consent Declaration and request regarding medical information
24067-202 (PDF) Electrocardiograph Request
24067-203 Audiometry Report (including advice on completion of the form)
24067-204 (PDF) In Flight Hearing Assessment Report
24067-213 (PDF) Respiratory Examination Report
24067-214 (PDF) Blood Pressure Examination Report
24067-215 (PDF) Headache Investigation Report
24067-217 (PDF) Aging Pilot Report
24067-300 Accredited Medical Conclusion - Request for Identification of Experts
MOT 1440 (PDF)  Special Report - Diabetes

Forms dealing with existing certificates

Form Title
24067-401 (PDF) Suspension of Certificate
24067-401 (Word) Suspension of Certificate
24067-402 (PDF) Restriction of Certificate
24067-402 (Word) Restriction of Certificate
24067-403 (PDF) Withdrawal of Conditions, Restrictions and Endorsements
24067-404 (PDF) Cancellation of Suspension of Certificate
24067-404 (Word) Cancellation of Suspension of Certificate
24067-405 (PDF) Extension of Suspension of Certificate
24067-405 (Word) Extension of Suspension of Certificate
24067-406 (PDF) Extension of Restriction of Certificate
24067-406 (Word) Extension of Restriction of Certificate
24067-407 Application for Replacement of a Medical Certificate