Check Out Our Forms Ahead of Time

Save time by downloading, printing, filling out the necessary forms, and bringing them to your appointment. Below are the forms normally associated with DOT physicals but only select the one that pertains to your situation.

Forms for download

  • Form MCSA-5875 (page 1-2) – to be completed by ALL CDL applicants, CDL holders, or anybody that is needing a medical card/certificate. 
  • Form MCSA-5870 (Insulin-treated Diabetes Mellitus Assessment Form) – to be completed for insulin-dependent drivers (completed by the doctor who is monitoring the driver’s diabetes and insulin use). INSULIN USE NO LONGER DISQUALIFIES A DRIVER. This form must be completed within 45 calendar days prior to the DOT physical.
  • Form MCSA-5871 (Vision Evaluation Report) – to be completed for individuals with monovision (can only see out of one eye). An Optometrist or Ophthalmologist must fill this out. This form must be completed within 45 calendar days prior to the DOT physical.
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