DOT Physicals

Keeping you safe while you roam.

If you are in need of a DOT Physical, please print pages 1, 2 and 3 of this form. Complete page 1 including the health history and bring all three pages with you to your appointment.

Select providers at The Doctors Clinic provide CDL Driver Medical Certification examinations. They are licensed in the State of Washington and are nationally registered with the Federal Motor Carrier Safety Administration (FMCSA).

The charge for the complete basic examination is $120.00. If you would like your insurance billed for this exam, please specify this at the time of request. We can also bill your employer if we have a contract established with them.

Examinations are done on an appointment basis.

Please expect your driver’s license to be checked to ensure its validity during your visit.

Be prepared to provide the following information:

• Prescription medications used recently or regularly: please note the name of medication, dose & frequency, diagnosis or reason for taking the medication, who prescribed it, how long you have been taking it
• Over-the-counter medications or herbal supplements used recently or regularly: please note the name of medication or supplement, dose & frequency, reason for taking the medication or supplement.
• Surgeries, (all): Type of surgery, date, where performed, name of surgeon.
• Illnesses or injuries requiring medical treatment during the past five years and/or any history of a seizure or a heart condition including: the type of illness or injury, inclusive dates of treatment, where treated, name of primary person (or facility) that provided treatment.
• Visual acuity, a hearing test, and a test of ability to distinguish traffic light colors will be done. If you wear glasses, contact lenses, or a hearing aid, bring them with you.
• You will be providing a urine sample to check for specific gravity, protein, blood, and sugar. (This is not a drug screen, unless one has been requested by your employer).

After reviewing your health history, we will perform your physical examination. Some individuals will be asked to provide documentation concerning evaluation by a specialist before certification can be given. Upon your successful completion of the examination you will be provided with a signed Medical Examiner’s Certificate.