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Step 1: Click the "Get Form" button at the top of this page to open the PDF editor.
Step 2: Enter the applicant's identifying information. Include the full name, date of birth, and Social Security Number (SSN) in the designated fields.
Step 3: Record the blood pressure and pulse readings for all three required days. Enter both the morning and evening measurements for each day. Use a properly sized cuff to ensure accurate blood pressure readings are obtained.
Step 4: Complete the examiner section. Enter the examiner's name, professional credentials, and signature on the designated line. The examiner must be a licensed doctor, nurse, or paramedical professional. This section certifies that all recorded measurements are accurate.
Tips for Accurate Completion
Always use the correct blood pressure cuff size based on the applicant's arm circumference. Verify all pulse readings before entering them into the form. Double-check that readings for all three days are recorded. Errors in blood pressure or pulse data can affect medical eligibility for service academy and ROTC programs.
Related Forms for Military Applicants
Service academy and ROTC applicants often need these additional forms: AFROTC Form 16, AFROTC Form 28, DD Form 2870, and DD Form 149.
Step 5: Review all fields for accuracy before submitting. Click "Done" to finalize the form. Your completed document is saved securely in your FormsPal account for future access and sharing.