FAA Medical Exam: What to Expect on Exam Day

Exam day starts long before you sit in the doctor's chair. Most of the work is paperwork, timing, and knowing what the AME will check. This guide walks you through the day in order, from the night before to the moment you walk out with your certificate or a deferral. It covers all three medical classes, with notes where first class adds steps.

Before Exam Day: Get Your Paperwork in Order

The FAA requires pilots to fill out FAA Form 8500-8 online in MedXPress before the exam. You bring the confirmation number to the appointment. The AME uses that number to pull up your application.

Two timing rules matter here. The MedXPress application stays valid for 60 days, so do not fill it out months early. And answer every question honestly. A false answer on this form is a federal offense.

Gather these items the night before:

Your MedXPress confirmation number
A government photo ID
Glasses or contact lenses, if you use them for flying
A list of your medicines, doses, and prescribing doctors
Names and dates of any past surgeries or hospital stays
Your most recent eye exam or hearing test results, if you have them
Payment for the exam fee

AMEs set their own fees. Prices vary by city and by class, so call the office for the current price before you go. If you have a known condition, such as sleep apnea or a history of depression, bring your treatment records. It can save a deferral later.

Step 1: Check In and Pay

Most exams take about 30 minutes, though a first class exam with an ECG takes longer. Arrive a few minutes early. The front desk will confirm your identity, collect your MedXPress number, and take payment.

This is a good moment to ask one question: "Is there anything in my history that might need extra review?" The staff often knows before the doctor does.

Step 2: The Paperwork Review

The AME reviews your MedXPress application with you. Expect questions about your medical history, medicines, and any visits to a doctor since your last exam. Answer plainly. If something has changed, say so. The AME can often work with a known, well-managed condition. Hiding it is what causes problems.

This is also when the AME decides whether your case fits a condition they can issue on the spot. Some conditions have worksheets, called Conditions AMEs Can Issue (CACI), that let the AME issue without sending your file to the FAA. Others may need a deferral.

Step 3: Vision and Hearing Checks

The exam starts with the senses you fly with.

Vision

Distant vision must be 20/20 or better in each eye for first and second class, and 20/40 for third class. You can wear glasses or contacts to meet this. Near vision must be 20/40 at 16 inches for all classes. The AME will also check that you can tell the colors you need to do your job safely.

Hearing

You will pass a conversational voice test at 6 feet with your back turned, or take an approved hearing test. The back-turned test is common and quick.

Step 4: Vitals and the Physical Exam

The AME checks your blood pressure and pulse. Blood pressure must be 155/95 or lower for all classes. If your reading is high on the day, ask whether you can sit quietly and retest. One high reading is not always the end of the process.

Then comes the physical. Expect the doctor to touch you and look closely at certain areas. The exam covers your heart, lungs, abdomen, and nervous system. The AME also checks your ears, nose, and throat, and looks at your spine and limbs.

You will also give a urine sample. The urinalysis checks for sugar or protein, which can point to diabetes or kidney disease. It is a screening test, not a drug test.

The ECG for First Class

Many first class exams for pilots age 35 and over need an ECG at age 35 and then each year after age 40. The test is quick and painless. If you are close to 35 or 40, ask the office when your next ECG is due so you can plan.

Step 5: The AME Makes a Decision

At the end of the exam, the AME does one of three things:

Issue the certificate on the spot. This is the common result for healthy pilots and for conditions covered by a CACI worksheet.
Deny the certificate. This is less common and usually tied to a condition that clearly does not meet the standard.
Defer the case. A deferral sends your file to the FAA Aerospace Medical Certification Division in Oklahoma City or to a Regional Flight Surgeon. Reviews can take weeks or months.

If the AME defers, ask what documents the FAA will want. Getting them ready early can shorten the wait. Some pilots with a history of a condition already approved by the FAA can be reissued by the AME under AME Assisted Special Issuance (AASI) rules.

Step 6: After the Exam

If you walked out with a certificate, check the class and the expiration date before you leave the office. The rules differ by class and age:

First class: valid 12 months under age 40 and 6 months at age 40 and over for first class privileges. It drops to second or third class privileges as time passes.
Second class: valid 12 months.
Third class: valid 60 months under age 40 and 24 months at age 40 and over.

If you were deferred, keep flying only if your current certificate is still valid. Do not assume a deferral means you are grounded. Ask the AME to explain your status in plain terms.

Some private pilots may qualify for BasicMed instead of holding a current medical certificate. The rules on aircraft and passenger limits changed under the FAA Reauthorization Act of 2024, so check the current FAA BasicMed page before you rely on it.

How to Make Exam Day Easier

A little prep goes a long way. Sleep well the night before. Skip heavy caffeine if your blood pressure runs high. Bring your medicine list in writing. And if you are choosing an AME for the first time, read about how we rank AMEs and use our directory to find an AME near you. Pilots in California, Texas, and Florida can browse listings by state.

If you are not sure which class you need, read FAA medical classes explained. If you have a condition that may need extra review, our Special Issuance guide walks through the process. And if you are weighing your options as a private pilot, see BasicMed vs third class.

Rules can change. Before your exam, check the FAA Guide for Aviation Medical Examiners or ask your AME about anything you are unsure of.

Key takeaways

Fill out FAA Form 8500-8 in MedXPress before the exam and bring the confirmation number. The application is valid for 60 days.
Bring your ID, glasses or contacts, medicine list, and payment. AMEs set their own fees, so call ahead for the price.
Expect vision and hearing checks, blood pressure, a urine sample, and a physical. First class exams may include an ECG at age 35 and yearly after age 40.
The AME can issue, deny, or defer. A deferral goes to the FAA and can take weeks or months, so ask what documents will be needed.
Check your certificate's class and expiration date before you leave, and confirm any rule questions with the FAA or your AME.

Common questions

Does a first class medical revert to a second class?

Yes. A first class certificate drops to second class privileges as time passes. For pilots under age 40, first class is valid for 12 months. At age 40 and over, it is valid for 6 months. After that, it can still work as a second or third class certificate, depending on the dates.

What is the pee test for FAA medical?

The urine test at an FAA medical exam is usually a quick check for sugar and protein. It is not a drug test. The AME uses it as a routine screening tool. If results are abnormal, the AME may ask for more information before issuing a certificate.

How long is a 2nd class medical good for over 40?

A second class medical certificate is valid for 12 months for commercial pilot privileges. This rule is the same for pilots under and over age 40. For first class privileges, the time is shorter for pilots age 40 and over. Always confirm current rules with the FAA.

What medical conditions disqualify you from flying?

Some conditions can lead to a denial or deferral, such as certain heart conditions, uncontrolled blood pressure, or some mental health histories. But many can be certified with a Special Issuance or a CACI worksheet. The AME decides if they can issue on the spot or must send the file to the FAA.

This guide is general information, not medical or legal advice. FAA rules change. Check the FAA Guide for Aviation Medical Examiners or ask your AME about your own case. Read our editorial policy.