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Please make sure your information is accurate before submitting.

First Name

Last Name:

Email:

Phone:

Date of Birth:

License Number:

Date of Last Medical:

Desired Medical Class:

Have you had any major health changes since your last examination? (If yes, you will need to book an in-person appointment)

Yes

Is this your 3rd virtual renewal in a row? (If yes, you will need to book an in-person appointment)

Yes

I require an in-person medical (In Ottawa, Ontario) because this is my first aviation medical OR I have already had 2 consecutive virtual renewals

Yes

Flying Hours Total (Class 1 and 3 only):

Flying Hours Last 12 Months (Class 1 and 3 only):

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