Format for certificate from registered medical practitioner (doctor)

This is to certify that Mr/Ms/Mrs …………………………………………………………....................

age ………… sex ……………….. has been examined for medical fitness at

……………….……... on date ……………….……...

Height …………………         Weight …………………         Chest …………………

Pulse …………………        Respiration …………………         Blood Pressure …………………

RS ………………………………………………………………………………………………………

CVS ………………………………………………………………………………………………………

Abdomen …………………………………………………………………………………………………

Vision ………………                 Rt ……………         Lt …………… Colour Vision ……………..…

Hearing ………………         Rt ……………         Lt ……………

Dental Checkup …………………………………………………………………………………………

Physical disability, if any ………………………………………………………………………………

Hemoglobin ……………………………… Blood Sugar (random) …………………………………..

Blood Group ……………………………………………………………………………………………

Comments ………………………………………………………………………………………………

He / She is found to be medically fit for studies as per above parameters.

Registered Medical Practitioner

Stamp