Submit Free Listing or Submit Updates

Please use this form to submit your updates (member or not) to your clinic location.

Location Title*
Location Address*
Street Address Address Line 2 City State ZIP Code
Services You Offer
- CDL / DOT Physical
- DOT Alcohol Testing
- DOT Drug Testing
- Merchant Mariner Exams
- School Bus Exams
- FAA Physicals
Other Key Services?
Office Hours*
Days You Are Open?*
- Open Monday
- Open Tuesday
- Open Wednesday
- Open Thursday
- Open Friday
- Open Saturday
- Open Sunday
Monday Open*

: Hours

Minutes

AM/PM
Monday Closed*

: Hours

Minutes

AM/PM
Tuesday Open*

: Hours

Minutes

AM/PM
Tuesday Closed*

: Hours

Minutes

AM/PM
Wednesday Open*

: Hours

Minutes

AM/PM
Wednesday Closed*

: Hours

Minutes

AM/PM
Thursday Open*

: Hours

Minutes

AM/PM
Thursday Closed*

: Hours

Minutes

AM/PM
Friday Open*

: Hours

Minutes

AM/PM
Friday Closed*

: Hours

Minutes

AM/PM
Saturday Open*

: Hours

Minutes

AM/PM
Saturday Closed*

: Hours

Minutes

AM/PM
Sunday Open*

: Hours

Minutes

AM/PM
Sunday Closed*

: Hours

Minutes

AM/PM
Your Website
Office Phone Number*
Office Fax
Office / Contact Email
Examiner Full Name and Title*
Examiner Type*
Enter the Other Examiner Type*
National Registry Number*
Certification Date*
MM slash DD slash YYYY
Consent*
I agree to the terms and conditions of Pass My Physical
I also agree that the information submitted here is accurate and complete and I also want it updated or added to the Pass My Physical system.
CAPTCHA