The Civil Aviation Act 2023 comes into force on 5 April 2025. We have a new set of forms for use after this date, while the original forms need to be used prior to this date.
24067-001 - Application for a medical certificate [PDF 432 KB]
24067-002 - Medical examination report [PDF 83 KB]
24067-003 - Medical assessment report [PDF 28 KB]
24067-004 - General direction submission form [DOC 72 KB]
24067-106 - Consent declaration and request regarding medical information [PDF 12 KB]
24067-202 - Electrocardiograph request [PDF 26 KB]
24067-203 - Audiometry report [PDF 89 KB]
24067-204 - In flight hearing assessment report [PDF 23 KB]
24067-211 - Special eye report [PDF 45 KB]
24067-212 - Operational colour vision assessment - PDF version [PDF 40 KB]
24067-212 - Operational colour vision assessment - Word version [DOCX 42 KB]
24067-213 - Respiratory examination report [PDF 25 KB]
24067-214 - Blood pressure examination report [PDF 22 KB]
24067-215 - Headache/migraine investigation report - PDF version [PDF 264 KB]
24067-215 - Headache/migraine investigation report - Word version [DOCX 60 KB]
24067-216 - Diabetes report - PDF version [PDF 34 KB]
24067-216 - Diabetes report - Word version [DOCX 124 KB]
24067-217 - Ageing pilot report [PDF 12 KB]
24067-401 - Suspension of certificate - PDF version [PDF 923 KB]
24067-401 - Suspension of certificate - PDF version [DOCX 44 KB]
24067-402 - Restriction of certificate - PDF version [PDF 950 KB]
24067-402 - Restriction of certificate - Word version [DOCX 43 KB]
24067-403 - Withdrawal of conditions, restrictions and endorsements - PDF version [PDF 923 KB]
24067-403 - Withdrawal of conditions, restrictions and endorsements - Word version [DOCX 80 KB]
24067-404 - Cancellation of suspension of certificate - PDF version [PDF 922 KB]
24067-404 - Cancellation of suspension of certificate - Word version [DOCX 40 KB]
24067-405 - Extension of suspension of certificate - PDF version [PDF 922 KB]
24067-405 - Extension of suspension of certificate - Word version [DOCX 41 KB]
24067-406 - Extension of restriction of certificate - PDF version [PDF 922 KB]
24067-406 - Extension of restriction of certificate - Word version [DOCX 40 KB]
24067-407 - Application for replacement of a medical certificate - PDF version [PDF 186 KB]
24067-407 - Application for replacement of a medical certificate - Word version [DOCX 292 KB]
24067-502 - Fit and proper person questionnaire – Medical Examiner designation [PDF 34 KB]
24067-001 - Application for a medical certificate [PDF 2.2 MB]
24067-002 - Medical examination report [PDF 83 KB]
24067-004 - General direction submission form [DOC 73 KB]
24067-202 - Electrocardiograph request [DOCX 34 KB]
24067-203 - Audiometry report [PDF 220 KB]
24067-204 - In flight hearing assessment report [PDF 115 KB]
24067-211 - Special eye report [PDF 1 MB]
24067-212 - Operational colour vision assessment [DOCX 39 KB]
24067-213 - Respiratory examination report [DOCX 39 KB]
24067-214 - Blood pressure examination report [DOCX 43 KB]
24067-215 - Headache/migraine investigation report [PDF 410 KB]
24067-216 - Diabetes report [PDF 332 KB]
24067-217 - Ageing pilot report [PDF 148 KB]
24067-401 - Suspension of certificate PDF [PDF 1.4 MB]
24067-401 - Suspension of certificate Word [DOCX 46 KB]
24067-402 - Restriction of certificate [DOCX 44 KB]
24067-403 - Withdrawal of conditions, restrictions and endorsements [DOCX 81 KB]
24067-404 - Cancellation of suspension of certificate [DOCX 41 KB]
24067-405 - Extension of suspension of certificate [DOCX 42 KB]
24067-406 - Extension of restriction of certificate [DOCX 42 KB]
24067-407 - Application for replacement of a medical certificate - PDF version [PDF 285 KB]
24067-407 - Application for replacement of a medical certificate - Word version [DOCX 293 KB]
24067-502 - Fit and proper person questionnaire – Medical Examiner designation [PDF 136 KB]
If you have any questions about this topic, use our contact form, or email med@caa.govt.nz
