Military Enlistment Physical Examination Form
Personal Information
Full Name
Date of Birth
Gender
Male
Female
Other
Address
Phone Number
Identification Number
Examination Date
Medical History
Allergies
Asthma
Heart Conditions
Diabetes
Serious Injuries
Major Surgeries
Other
If any, please specify:
Physical Examination
Height (cm)
Weight (kg)
Blood Pressure
Vision
Hearing
Other Remarks
Physician Evaluation
Fit for Service
Yes
No
Conditional
Physician Name
Signature
Date