Da Form 4707 – Fill Out and Use This PDF

Enter the Date of the Entrance Physical Standards Board (EPSBD) Proceedings, then in Box 1 the Name of Service Member (Last, First, MI), in Box 2 the SSN and in Box 3 the Grade.

Enter in Box 4 the Medical Treatment Facility, in Box 5 the Component, in Box 6 the Organization and in Box 7 the Date Entered Curr Tour of AD.

In Box 8, Findings by the Evaluating Physicians: the board finds that the service member was medically unfit for appointment or enlistment in accordance with current medical fitness standards and in the opinion of the evaluating physicians the condition(s) existed prior to service, and enter the medical conditions and/or physical defects as a brief narrative summary.

Enter the State Profile and Assignment Limitations in Box 9 and the Typed Name, Grade & Specialty of Physician(s)/Dentist(s) in Box 10, with the Signature(s) in Box 11.

In Box 12, the findings are Approved or Disapproved (State reason in continuation section on reverse. Identify by Item No.). Then enter the Typed Name, Grade & Title of Medical Approving Authority in Box 13, the Signature in Box 14 and the Date in Box 15.

Enter the To (Commander of Service Member) in Box 16 and the From (MTF Commander) in Box 17, then the Typed Name, Grade & Title of MTF Commander in Box 18, the Signature in Box 19 and the Date in Box 20.

In Box 21, Action by Service Member: I have been informed of the medical findings. Additionally, I understand that legal advice of an attorney employed by the Army is available to me or that I may consult civilian counsel at my own expense. I also understand that I may request to be discharged from the Army without delay or to request retention on active duty. If retained, I my be involuntarily reclassified into another military occupational speciality based upon my medical condition.

In Box 21, Action by Service Member, the service member marks one. I concur with these proceedings and request to be discharged from the Army without delay. I concur with these proceedings and request that I be retained on active duty. I disagree with these proceedings because my condition did not exist prior to service (specified medical evidence is attached) and request my case be returned to the medical approving authority for reconsideration. I disagree with these proceedings because my condition was not disqualifying on entry and was aggravated by service (specific medical evidence is attached) and request my case be returned to the medical approving authority for reconsideration.

Enter the Typed Name, & Grade of Service Member in Box 22, the Signature in Box 23 and the Date in Box 24.

In Box 25, the unit commander marks Recommend: Service member be discharged/separated, Service member be retained, or Case be returned to the medical approving authority.

Enter the Typed Name, Grade & Title in Box 26, the Signature in Box 27 and the Date in Box 28.

In Box 29, the discharge authority marks Service member will be discharged/separated from the Army or Retained on active duty.

Enter the Typed Name, Grade & Title in Box 30, the Signature in Box 31 and the Date in Box 32.

Identify each continued item by number in the Continuation section.