Medical Form

Please print and take this form to your medical doctor (M.D) to be completed.

AIM Academy
455 Spadina Ave., Suite 300  Toronto, Ontario M5S 2G8
Telephone:  (416) 323-1818  or  Toll free:  (800) 263-1703 (USA & Canada only)

Applicant Name:
Date:

(   ) Is the above in good health and free of communicable diseases?
Comments:
 

 
(   ) Results of T.B. Test
Comments:
 

 
Is the above named person fit, healthy and able to work with the public?
(   ) Yes           (   ) No
If No, please explain why.  Thank You.
 
 

Physician’s Contact

Address:                                                                             Phone:

 

________________________                                      _________________________
Doctor’s Name (please print)                                 Doctor’s Signature