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DoDMERB Medical Questionnaire

IMPORTANT INFORMATION:
- Estimated time: 30-45 minutes depending on the issues
- Please have a parent complete this questionnaire, or complete it together
- You can save progress and return later in the same browser
- Please answer all questions honestly and completely
- Many candidates discover relevant medical issues they didn't initially consider
- We will review your answers and provide a summary
WHY SO DETAILED?
The DoDMERB process requires documentation of ALL medical history. Even seemingly minor issues can affect your qualification. This comprehensive questionnaire ensures we address everything.

Candidate Full Name

Please describe any known major medical issue(s) that will result in a disqualification

Please use language that aligns with DoDI 6130.03 if known.

Upload all medical records related to this issue(s)

Untitled checkboxes field