Appointment Setup for Aviation Medical

Name:

Best Telephone to reach you:

Email to reach you:

Best time to reach you mornings afternoon evening via email anytime

My medical is due: June July August September October November December Overdue 1st Time

I need a Class I with ECG I w/o ECG II III Student or unsure Seeking Primary Care Appointment

I would prefer to have my medical done in Burlington Vermont - Heritage Flight Center Willsboro NY Lake Placid New York Other  

   If Burlington selected, you could select one of the following days none of the above works for me Wednesday November 2nd Wednesday November 9th Wednesday November 16th Saturday December 3rd Wednesday December 7th Wednesay December 14th

   If Willsboro selected, we book on Mondays and Fridays

   If Lake Placid, we book on Tuesdays and Thursdays (no EKGs available here)

    If this form doesn't want to work, just forward an email to iwantaflightphysical@docjosh.com with your requests and we will respond to you.