Before your DOT physical / Forms and documents
Use the form your medical examiner requested. These links open Beyond Wellness packets with clinic return instructions and official FMCSA forms. Examiner contact details are prefilled only where appropriate; driver and treating-provider fields remain blank. Read the instructions before completing or sending a form.
Not sure which one you need? Start with the preparation checklist or call 704-461-1836. Optional forms are not required for every driver.
Your clinician who manages and prescribes insulin completes this assessment when the insulin-treated diabetes standard applies.
Open Beyond Wellness Insulin-treated diabetes assessment, MCSA-5870 packet (PDF)
FMCSA source and current download
Your treating clinician provides the requested information. Use this optional form only when requested by the medical examiner.
Open Beyond Wellness Non-insulin diabetes assessment, MCSA-5872 (optional) packet (PDF)
FMCSA source and current download
An ophthalmologist or optometrist completes this report when the alternative vision standard applies. Wearing glasses alone does not mean you need this form.
Open Beyond Wellness Alternative vision evaluation, MCSA-5871 packet (PDF)
FMCSA source and current download
The examiner completes the request section; your prescribing healthcare provider completes the provider section when requested. This is an optional form.
Open Beyond Wellness Medication information, MCSA-5895 (optional) packet (PDF)
FMCSA source and current download
An application does not itself grant an exemption or SPE certificate. Follow the applicable packet and your individual approval terms.
For applicants seeking a new federal hearing exemption. The applicant gathers the records and submits the application to FMCSA.
Open Beyond Wellness Hearing exemption: new application packet (PDF)
FMCSA source and current download
For holders applying to renew an existing federal hearing exemption. Follow the packet and your individual approval terms.
Open Beyond Wellness Hearing exemption: renewal application packet (PDF)
FMCSA source and current download
For applicants seeking a new federal seizure exemption. The applicant gathers the records and submits the application to FMCSA.
Open Beyond Wellness Seizure exemption: new application packet (PDF)
FMCSA source and current download
For holders applying to renew an existing federal seizure exemption. Follow the timing and record instructions in this packet.
Open Beyond Wellness Seizure exemption: renewal application packet (PDF)
FMCSA source and current download
January 2026 packet for a driver applying for an initial Skill Performance Evaluation certificate. Follow its driver, medical and other supporting-document instructions.
Open Beyond Wellness SPE certificate: initial application packet packet (PDF)
FMCSA source and current download
January 2026 packet for a driver renewing an existing Skill Performance Evaluation certificate. An application is not an issued certificate.
Open Beyond Wellness SPE certificate: renewal application packet packet (PDF)
FMCSA source and current download
This authorization concerns disclosure of medical information in an FMCSA public docket. It is not a routine release to this office and is not permission to send text messages. Read both pages and follow the exemption program’s instructions.
For the applicant in an FMCSA exemption application. Read both pages: it addresses disclosure of medical information in a public docket. It is not the clinic's routine records release or permission to text.
Open Beyond Wellness FMCSA exemption authorization for release of information packet (PDF)
FMCSA source and current download
Follow the office’s intake instructions. These reference copies do not replace the office’s current examination workflow.
Reference / office use. The driver completes the driver information and health history; the medical examiner completes the examination and determination. Follow the office's intake instructions.
Open Beyond Wellness Medical examination report, MCSA-5875 packet (PDF)
FMCSA source and current download
Examiner-issued certificate, for reference / office use. Drivers must not complete or issue their own medical certificate.
Open Beyond Wellness Medical examiner's certificate, MCSA-5876 packet (PDF)
FMCSA source and current download
For sleep apnea treatment reports, PCP or specialist records and requested HbA1c results, follow the examiner’s specific request. No new clinic request form is provided here.
Official downloads were checked October 22, 2026. Use each FMCSA source link to check for a newer form. The OMB date printed on a federal form is not your medical certificate expiration date.
These instructions help you prepare. The certified medical examiner determines which records are needed and whether you meet the applicable standards. Bringing a form does not guarantee certification.
