Request for Medical Appt
Complete this form to set-up a 'Fit for Duty' medical exam with a member of UFS Academy Staff
Your OFFICIAL UFS NAME (as per your UFS Service Jacket) *
Your RANK *
Your EMAIL address *
Repeat your EMAIL *
Availability for Appointment: Please list 1st preference for day and time SLT (allow 30 minutes). For example: Mon between 1pm and 3pm SLT *
Availability for Appointment: Please list 2nd preference for day and time SLT (allow 30 minutes). For example: Tue between 9pm and 10pm SLT *
Availability for Appointment: Please list 3rd preference for day and time SLT (allow 30 minutes). For example: Sat between 10am and 4pm SLT *
Submit
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This form was created inside of United Federation Starfleet.