D.O.T. Physical Exam Form

Thank you for choosing Carl Willeford, Jr., MSN, FNP-C, as your Medical Examiner for your required Department of Transportation physical. 

You will save time on the day of your physical appointment by printing and filling out the required paperwork prior to arrival.

Please take the following steps to be prepared prior to your physical.

  • Open and print the DOT patient paperwork packet in the box to the right. Expect a total of approximately eleven or twelve pages, depending on your printer settings.
  • Fill in all patient information, where indicated, prior to coming to your appointment.
  • IF you are presently taking prescription medications, also print the CMV Driver Medication Form, fill in the appropriate information and bring it with your other paperwork to your appointment.
  • Bring all forms to your appointment for Mr. Willeford to finish completing during the examination.

DOT Medical Examination Report Form

DOT Medical Examiner's Certificate Form