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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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