Clearance For Pilots / US Military Personnel

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Patient Name*

Date of Birth*

Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Notes

Please attach FAA form or Doctor's Clearance Request here

Max. file size: 150 MB.

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Clearance For Pilots / US Military Personnel

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Have you had LASIK or lens implant surgery in the past?