Ds 3057-2026

1. Click ‘Get Form’ to open the ds 3057 in the editor.
2. Begin by filling out the demographic information on page 1. Enter your name, date of birth, and sex in the designated fields.
3. Indicate your status (Employee, Spouse, or Dependent Child) and provide your health insurance plan details.
4. Complete the contact information section, including telephone number and email address where you can be reached for the next 90 days.
5. On page 2, answer all medical history questions thoroughly. Attach additional pages if necessary for detailed responses.
6. Review your entries for accuracy and completeness before signing at the bottom of the form.
7. Once completed, scan the signed form and submit it via email in PDF format to MEDMR@state.gov.

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