AOPA BasicMed Physician Directory Consent Form

Thank you for your interest in joining the Aircraft Owners and Pilots Association’s public directory of state-licensed physicians who are available to perform BasicMed examinations.

For the Aircraft Owners and Pilots Association (AOPA) to share your information with the public and publish it in our directory, it is important that we receive your consent to do so. AOPA’s use of the information that you provide is not a recommendation or endorsement of you by our association. The information you provide is offered to the public free of charge as a resource to assist pilots in locating nearby physicians.

If corrections are required to any information provided below, or you wish to withdraw this consent, please contact Amelia Walsh by email at amelia.walsh@aopa.org, or by telephone at 301.695.2195.

Please acknowledge the following:





“Physician Qualifications. The FAA relies on the determination of each State (as well as each territory and possession of the United States) as to which persons it will license as physicians. If the person holds a license as a physician issued by any State, territory, or possession, then they meet the requirement as a state-licensed physician. The FAA notes that all States license medical doctors (M.D.) and doctors of osteopathic medicine (D.O.) as physicians; although Federal and some State laws may permit the licensure of other persons, such as doctors of dental surgery (D.D.S.), as physicians. While the FAA expects that these specialists (e.g., D.D.S., dentist, podiatrist, etc.) who do not also hold an M.D. or D.O. would not have the breadth of training for a BasicMed medical examination, the FAA will rely on each State-licensed physician to determine whether he or she is qualified to conduct the medical examination. Physicians should refer to their State medical licensing authority for further guidance.”FAA Advisory Circular 68-1A, page 7-4, located here: https://www.faa.gov/documentLibrary/media/Advisory_Circular/AC_68-1A.pdf


I consent to AOPA including the following information about me in the directory:




















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