Language
English (US)
Nederlands
Waaldijkstraat 115 - HCS building
Application for FAA/ CASAS medicals. Please note that you may need an ECG (10 usd) and or Audio(30 usd) test. Payment is cash or by debit card at the clinic in SRD or USD. Please bring with you: ID, glasses (if used), list of medication used.
For more information or assistance, please email info@hcs.sr or call +597- 470200
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Preferred appointment date and time
*
Name
*
First Name
Family Name
Age
Phone number
*
Email
*
example@example.com
Sex
*
Please Select
Female
Male
Nationality
*
ID number
*
SR number (SR/ .............) This is written on your white medical pass and consists of 4 digits. In case this is your first medical , please write N.A.
*
Type of medical
*
Please Select
CASAS
FAA
CASAS & FAA
For FAA please fill in this form and send the code received to info@hcs.sr https://medxpress.faa.gov/medxpress/
Date last audio
*
-
Day
-
Month
Year
Date Picker Icon
Date last ECG
*
-
Day
-
Month
Year
Date Picker Icon
Function
*
Please Select
Pilot
Student
Air traffic Controller
Company name
*
Expiration date Medical
*
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A confirmation email with details will be sent after submitting this form. Please look out for it (spam) and read it carefully. Please email us at info@hcs.sr or call us at 470200 if in need of any assistance.
Please check spam and junkmail for this form
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