DA Form 3425-R Medical Fitness Statement for Enrollment in Basic Course, Senior Rotc

DA Form 3425-R - also known as the "Medical Fitness Statement For Enrollment In Basic Course, Senior Rotc" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 3425-R - was last revised on September 1, 1968. Download an up-to-date fillable PDF version of the DA 3425-R down below or look it up on the Army Publishing Directorate website.

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DATE
MEDICAL FITNESS STATEMENT
FOR ENROLLMENT IN BASIC COURSE, SENIOR ROTC
For use of this form, see AR 145-1; the proponent agency is ODSCPER
I have examined
and find no medical
(First Name - Middle Initial - Last Name)
condition or physical impairment that precludes his participation in the basic course, Army ROTC, a
program not more physically strenuous than a normal college physical education program.
SIGNATURE OF PHYSICIAN
DA FORM 3425-R, 1 SEP 1968
APD LC v2.00ES
DATE
MEDICAL FITNESS STATEMENT
FOR ENROLLMENT IN BASIC COURSE, SENIOR ROTC
For use of this form, see AR 145-1; the proponent agency is ODSCPER
I have examined
and find no medical
(First Name - Middle Initial - Last Name)
condition or physical impairment that precludes his participation in the basic course, Army ROTC, a
program not more physically strenuous than a normal college physical education program.
SIGNATURE OF PHYSICIAN
DA FORM 3425-R, 1 SEP 1968
APD LC v2.00ES
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