Medical Certification Forms

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Forms required for Medical Certification

Form Title
24067-001 Application for Medical Certificate
Online Payment for Medical Certification
24067-407 Application for Replacement of a Medical Certificate
24067-002 Medical Examination Report
24067-003 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 Consent Declaration and request regarding medical information
24067-202 Electrocardiograph Request
24067-203 Audiometry Report (including advice on completion of the form)
24067-204 In Flight Hearing Assessment Report
24067-213 Respiratory Examination Report
24067-214 Blood Pressure Examination Report
24067-215 Headache Investigation Report
24067-217 Aging Pilot Report
24067-300 Accredited Medical Conclusion - Request for Identification of Experts
MOT 1440  Special Report - Diabetes

Forms dealing with existing certificates

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