DOT Medical – Own Doctor Request

This form/request should NOT be completed any sooner than 30 days before you are planning on going to your doctor for your medical certificate. The medical examiner that you see must be approved and listed on the FMCSA National Registry.

You can go to the following website to check if your medical examiner is on the registry: https://nationalregistry.fmcsa.dot.gov/search-medical-examiners
I understand that I am responsible for the cost of the medical when I go to my own doctor(Required)
I understand that if the medical examiner is not on the registry, the medical will not be accepted(Required)
Name(Required)
MM slash DD slash YYYY
I understand that I must submit a copy of the medical to Windstar Lines and take it to DMV immediately(Required)

You will receive an email response back approving your request to go to your own doctor.