Forms
In order to avoid delays in your certification, please bring the following forms to the office with you if they are applicable.
If you use CPAP, please have a copy of your 365-day CPAP compliance report with you at your visit, or have it emailed to admin@fit2drivemedical.com or faxed to (978) 824-0208.
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Please fill out pages 1 & 2 ONLY. You can bring this with you to your appointment or send to our office via email or fax.
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Form needs to be completed no more than 45-days PRIOR to your exam and brought in to the office with you for your visit.
Form to be completed by an ophthalmologist or optometrist.
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Form must be completed no more than 45-days PRIOR to your DOT exam and brought into the office with you for your visit.
Form is completed by the healthcare provider that manages and prescribes insulin for the treatment of the diabetes.
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Fill out this form if you are a school bus driver with a history of diabetes.
Form must be completed by an endocrinologist.
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This form is for individuals to obtain a US Merchant Mariner Credential (MMC) which is issued by the United States Coast Guard.
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Please complete and email to admin@fit2drivemedical.com