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- Click ‘Get Form’ to open it in the editor.
- Begin by entering your personal information in the designated fields: Last Name, First Name, Middle Name, Date of Birth, and Social Security Number. Ensure accuracy as this information is crucial for identification.
- Fill in your address details including City, Province, and Postal Code. This helps in maintaining accurate records.
- The physician will need to complete the examination section. They should check either 'Passed' or 'Failed' based on their assessment of your physical condition.
- Your physician must provide their information including Name, Mailing Address, License Number, Office Phone Number, Date, and Signature. This validates the examination results.
- Once completed, you can download the form as a PDF and print it for submission to your physician or send it via email as specified.
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