Pilot Physician - Airman Registration
You'll need the Medxpress number to complete the FAA medical. To get the number, visit: https://medxpress.faa.gov/medxpress/

Face masks / coverings are still required in our office and building for your health and safety.

Drink plenty of water prior to your arrival. 

If you wear contacts/glasses, have them with you. 

If you are sick or not feeling well, reschedule your appointment.

GILBERTO MUNOZ M.D., M.P.H.
TERESA CVENGROS M.D.
2800 N Sheridan Road, Suite G2, Chicago, IL 60657
773-755.2600 | webinfo@pilotphysician.com
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First and Last Name *
Please include your full name
Your Date of birth *
MM
/
DD
/
YYYY
Your Gender *
Your Cell Phone Number *
Include your Country Code if not a US number
Your Address *
Include Street, Unit, City, State and Zip Code
Your Email Address *
Include Street, Unit, City, State and Zip Code
Medical Certificate Class *
Select the medical class certificate desired. FOR CONSULTATIONS: please bring all pertinent medical records to your appointment.
Class 1
Class 2
Class 3
Consultation
FAA
ECG *
Class 1 airmen over the age 35 are required to complete an ECG. If you are 35+, provide the date of your last ECG & facility. Write NA if this does not apply. If you had an EKG elsewhere, please bring a copy of the document with you.
Do you hold any of the following designations with your medical certificate? *
FAA Medxpress Confirmation Number *
For Consultations enter NA. To obtain the Medxpress number, visit https://medxpress.faa.gov/medxpress/
How did you hear about us?
Terms
Financial Arrangements: Payment in full is expected at each appointment.

For your convenience we accept cash, check, or most major credit cards.
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