Your First FAA Medical Exam: The Complete Guide for Student Pilots

Your first FAA medical exam can feel like a big unknown. The good news is that most of it is routine, and what trips people up is usually preparation, not health. This guide walks you through when to get your medical, which class to choose, how to fill out MedXPress, what happens in the exam room, and what to do if your exam doesn't end with a certificate in hand.

When to Get Your First Medical

Under 14 CFR 61.23(a)(3)(i), you need at least a third-class medical certificate to exercise the privileges of a student pilot certificate, unless you fly under BasicMed or train in a glider or balloon. The FAA's student pilot certificate page says you need a student pilot certificate before you can fly solo, not to take flying lessons, and that you must carry both your student pilot certificate and your medical certificate when you fly solo.

So the deadline is your first solo, but the practical advice is to go sooner, before you spend much money on training. If your history includes a condition or medication the FAA needs to review, you'll find out early and can gather records while you train, instead of waiting when your instructor says you're ready to solo.

What about BasicMed? BasicMed can cover student pilot privileges under 14 CFR 61.23(c), but one of its requirements is that you have held an FAA medical certificate at some point after July 14, 2006. If you've never had one, BasicMed isn't available to you yet, and your first step is a traditional medical exam. Our BasicMed vs. traditional medical comparison explains the rest of the BasicMed rules.

Which Class Should You Get?

There are three classes of medical certificate. Under 14 CFR 61.23(a), you need a first-class medical to exercise pilot-in-command privileges of an airline transport pilot (ATP) certificate, at least a second-class medical to exercise commercial pilot privileges in most aircraft, and at least a third-class medical to exercise private, recreational, or student pilot privileges.

For a private pilot certificate, a third-class medical is all you need. But the FAA's AME Guide says you may apply for any class whose standards you meet, and you don't need an ATP certificate to get a first-class medical. If you're considering an airline career, a first-class exam up front tells you early whether you meet the stricter standards: 20/20 distant vision instead of 20/40, an ECG once you reach 35, and an exam by a Senior AME.

How long your certificate lasts depends on the privileges you use and your age on the date of your exam. Every period runs through the end of the month of your exam, plus the number of calendar months in this table, which summarizes 14 CFR 61.23(d).

A higher-class certificate steps down when its higher-class period ends. For example, if you're 22 and get a first-class medical in March 2027, it covers first-class privileges through the end of March 2028 and still covers student and private pilot privileges through the end of March 2032.

Step 1: Complete Your Application in MedXPress

Every FAA medical exam starts with FAA Form 8500-8, which you fill out online in FAA MedXPress before your appointment. You only need a valid email address to create an account. Here's how the process works, based on the FAA's How to Obtain a Medical Certificate page and MedXPress FAQs:

• Request an account with your name and email address. The FAA emails you a temporary password.
• Before you start the form, gather a list of every medication you use (prescription and nonprescription), your medical history, and your visits to health professionals over the past 3 years.
• Work through the questions. If a question isn't clear, click any row marked with a "+" or the 8500-8 Instructions link for help.
• Submit within 30 days of starting. An application that isn't submitted within 30 days of creation is removed from the system.
• After you submit, you'll get a confirmation number. Print or save a copy of your application. Your AME can't access your application without that number.
• Schedule your exam right away. Your exam must happen within 60 days of submitting, or the application is deleted.

Answer every question completely and honestly, including old or resolved conditions. Disclosing something doesn't mean you'll be denied, but leaving it off can cost you your certificates and carries criminal penalties. If you entered something incorrectly, the FAA says your AME can make corrections at your exam. For a question-by-question walkthrough, use our MedXPress Prep tool, and read 6 common MedXPress mistakes before you submit.

Step 2: Gather What to Bring

On exam day, bring:

• Your MedXPress confirmation number
• A government-issued identification card, so the office can verify who you are
• The glasses or contact lenses you normally wear, because the AME tests your vision with them
• A list of all your medications with doses, matching what you entered in MedXPress
• Copies of medical records for any current or past condition, or any medication, that the FAA asks about

That last item often decides whether you leave with a certificate. The FAA recommends that anyone with a current or past condition, or who takes medication, look up the requirements in the Guide for Aviation Medical Examiners. Each condition's disposition table has an Evaluation Data column listing what your AME needs, and the FAA's Know Before You Go booklet explains how to read these tables. With the right documents, your AME may be able to issue at the exam. Without them, certification may be delayed.

For some conditions, the FAA wants a current, detailed Clinical Progress Note from a visit with your treating physician or specialist no more than 90 days before your AME exam. A patient portal After Visit Summary is not enough, because it may leave out information the FAA needs. The FAA describes a detailed progress note as including a summary of the history of your condition, current medications with doses and any side effects, exam findings, test results, your diagnosis, the assessment and plan, and a prognosis. Prognosis isn't always on a standard note, so ask your doctor to add it.

Step 3: What Happens at the Exam

When you arrive, the office staff will ask for your MedXPress confirmation number to import your application and check your ID. According to the FAA, your AME or their staff will then collect your vital signs (height, weight, pulse, and blood pressure), test your eyes, test your hearing, collect a urine sample, and perform an ECG if one is required.

Your AME must personally review your medical history with you and perform the physical exam, which covers your eyes, ears, nose, and throat, heart and lungs, abdomen, musculoskeletal system, skin and identifying marks such as tattoos, and a neurological check of your reflexes. The AME also forms a general impression of your mental wellness through conversation. Genitourinary and breast exams are only done if your history calls for it or at your and the AME's discretion, there's no pelvic exam, and you can have your personal physician provide a report instead.

Here's what each test checks, based on the FAA's Synopsis of Medical Standards.

Vision

Each eye is tested separately, with or without glasses or contacts.

If you need glasses or contacts to meet any of these standards, that's fine. Your certificate will carry one limitation: "Must Use Corrective Lens(es) to meet vision standards at all required distances." Contact lenses that correct only near or intermediate vision are not acceptable for flying. Our vision guide covers eye surgery, glaucoma, and other eye conditions.

Color Vision

Color vision testing changed on January 1, 2025. Pilots now take one of three approved computer-based tests: the Colour Assessment and Diagnosis (CAD) test, the Rabin Cone Test, or the Waggoner Computerized Color Vision Test. Testing must be done in person, and virtual, downloaded, or printed versions aren't allowed. It's a one-time screening, and you can attempt any or all of the approved tests. Passing any one counts as a pass. Color-correcting lenses such as X-Chrom are not accepted.

If you can't pass any approved test, your AME can still issue a third-class certificate with limitation #104, "Valid for day visual flight rules (VFR) only," and you can appeal to the Federal Air Surgeon if you want an upgrade to first or second class. If your AME's office doesn't have an approved test, the FAA's color vision screening steps say the AME can issue a third-class certificate with that same limitation instead of deferring, or you can take the test at another location that sends the printout to your AME. So when you book, ask whether the office has an approved computer-based test.

Hearing

The standard is the same for every class. You must hear an average conversational voice in a quiet room, using both ears, at 6 feet, with your back to the examiner. If you don't pass, the AME may use pure tone audiometry, and if that fails too, a speech discrimination test (passing is at least 70 percent in one ear at no more than 65 dB).

Blood Pressure

Your average seated blood pressure should not exceed 155 systolic and 95 diastolic, for all classes. If your reading is high, the AME has options before deferring: recheck it during the visit, have you come back on 3 separate days over a 7-day period, or send you to your treating physician for re-evaluation. On blood pressure medication? See our hypertension guide.

Urinalysis

You'll give a urine sample. FAA policy requires AMEs to have strips that test urine for sugar and protein, and the AME Guide says sugar (glycosuria) or protein (proteinuria) in the urine is cause for deferral until more testing shows the status of your endocrine or urinary system. Trace or 1+ protein without a history of kidney disease is not cause for denial.

ECG (First Class Only)

For first-class applicants, 14 CFR 67.111 requires an electrocardiogram at the first application after your 35th birthday and then every year after your 40th birthday. An ECG counts if it is dated no earlier than 60 days before the application it goes with. ECGs aren't routinely required for second- or third-class certificates. If you're under 35, you won't need one even for a first-class exam.

Common Worries That Are Often Manageable

Here's what the FAA actually says about three common worries.

Glasses or Contacts

Needing glasses or contacts doesn't stop you from holding any class of medical certificate. Bring the lenses you use and wear them when you fly. If you've had LASIK or another eye surgery, check our vision guide for recovery periods.

Mild, Well-Controlled Asthma

Asthma is on the FAA's list of conditions an AME can issue at the exam when specific criteria are met. Under the FAA's CACI Asthma Worksheet, your AME reviews a current, detailed Clinical Progress Note from a visit with your treating physician or specialist within 90 days of the exam, and can issue if you meet all of these:

• Your treating physician finds your asthma stable on your current treatment, with no changes recommended.
• Symptoms happen no more than 2 days per week, you use a rescue inhaler no more than 2 times per week, and you've needed oral steroids for flare-ups no more than 2 times per year.
• In the last year, you've had no hospital admissions and no more than 2 clinic or urgent care visits for flare-ups, with symptoms fully resolved.
• Your medications are limited to inhaled long-acting or short-acting beta agonists (such as albuterol), inhaled corticosteroids, or leukotriene receptor antagonists (such as montelukast). Monoclonal antibody treatments don't qualify for this pathway.
• Your spirometry (breathing test) from within the last 90 days shows FEV1 and FVC both at least 80 percent of predicted before bronchodilators. Spirometry isn't required if your only treatment is an as-needed short-acting inhaler on one or two days a week.

If you don't meet every item, your AME defers and the FAA decides, which may lead to a Special Issuance. A short course of oral steroids during a flare-up is acceptable, but the FAA says not to fly until you've finished the course and are symptom-free.

ADHD as a Child

An ADHD diagnosis in your past isn't automatically disqualifying, but you shouldn't assume the AME can simply wave it through. Any ADHD history needs an evaluation. The FAA's Fast Track is for pilots who, in the past 4 years, have had no ADHD treatment or medication for any condition, no ADHD symptoms, and no instability at school, work, or in social life, and who have no other psychiatric diagnosis, current or past. On the Fast Track, a doctoral-level psychologist or neuropsychologist reviews your records and interviews you, with no testing required, and your AME can issue if the FAA's criteria are met.

Everyone else goes on the Standard Track, with in-person testing by an FAA HIMS neuropsychologist and an FAA review. Either way, the records list is long, including 4 years of pharmacy and driving records and all academic transcripts, so start early. Our ADHD guide explains both tracks.

Conditions That Need Attention Before Your Exam

Some conditions and medications mean your AME can't issue at your first exam, or can only issue with specific paperwork. None automatically ends your path to flying, but preparing before you submit MedXPress saves time. Never stop or change a medication on your own to get through an exam.

• Medications on the FAA's Do Not Issue list. The FAA's Do Not Issue and Do Not Fly tables tell AMEs to defer for drug classes that include ADHD medications and other stimulants, most psychiatric medications, seizure medications, high-dose steroids, and open prescriptions for chronic use of a controlled substance, including medical marijuana.
• Current ADHD medication. If you take any ADHD medication, including as-needed use, or stopped within the past 90 days, the AME must defer. See the ADHD guide.
• Antidepressants. Nine antidepressants are conditionally acceptable under the FAA's Antidepressant Protocol, but the AME can't issue your first certificate and you'll work with a HIMS AME. See the antidepressant guide.
• Sleep apnea. Treated obstructive sleep apnea is usually handled through an AME Assisted Special Issuance once you show your treatment works. See the sleep apnea guide.
• Diabetes treated with medication. Any diabetes medication requires a Special Issuance, and the AME must defer your first exam. See the type 2 diabetes guide.
• A DUI or other alcohol or drug history. You must report every event on MedXPress, and a separate 60-day report to FAA Security may also be required. See the substance use history guide.
• A heart attack, stent, or other heart procedure. See the cardiac event guide.

Over-the-counter medications matter too. For example, the FAA says not to fly for 60 hours after a dose of the sedating antihistamine diphenhydramine (Benadryl). Before your appointment, run every medication you take through our Medication Checker.

How to Find an AME

An Aviation Medical Examiner is a physician the FAA has designated to perform airman medical exams. Any AME can perform second- and third-class exams. Under FAA Order 8000.95D, only Senior AMEs have the authority to perform first-class exams, so confirm that before you book if you want a first-class medical.

You can search ClearedMed's AME Directory by location, and the FAA also suggests asking pilot advocacy groups or local flight schools for recommendations. As for cost, the FAA does not set AME fees. It recommends that examiners charge the usual and customary fee for similar services in their area, so prices vary. Ask when you call.

When you call, ask whether the AME performs first-class exams, whether the office has an approved color vision test, and what records to bring. Our guide on how to find the right AME covers more.

Issued, Deferred, or Denied: What Each Outcome Means

At the end of your exam, the AME has authority to do one of three things: issue your certificate, defer the decision to the FAA, or deny it. If your required documents are present and reviewed, and everything meets the medical standards in 14 CFR part 67, the AME will issue your certificate. For some conditions, or if required documents are missing, the AME must defer. The FAA says an AME denial for a specifically disqualifying condition happens only in very rare cases.

Your AME must send your exam to the FAA within 14 days. Under 14 CFR 67.407, even an AME-issued certificate can be reversed by the FAA within 60 days, or within 60 days after receiving additional information it requested.

A deferral is not a denial. It means the FAA needs to review your case, usually because it needs more information. You'll get a letter from the FAA, and most letters list the items you need to provide, which are usually medical records. If records are required, get the actual current, detailed Clinical Progress Notes from your provider, no more than 90 days old, not patient portal summaries. The FAA says the fastest way to get documents to the FAA is to take them to your AME, who can add them to your record electronically. If you don't provide everything requested, your certificate will be delayed or your application denied.

If the AME denies your application, 14 CFR 67.409 lets you ask the Federal Air Surgeon in writing to reconsider within 30 days of the denial. If you don't ask within 30 days, you're considered to have withdrawn your application. If the FAA itself denies you, the FAA says you'll receive instructions on how to appeal. And as the FAA puts it, don't panic. Many pilots who are denied may still be eligible for certification through a Special Issuance under 14 CFR 67.401, which requires more medical information and usually has a shorter duration, but typically lets you fly the same way as a pilot with an unrestricted certificate.

A denial also matters for BasicMed: under 14 CFR 61.23(c), you can't use BasicMed if your most recent medical application was completed and denied.

Your Student Pilot Certificate Is a Separate Step

Your medical certificate and your student pilot certificate are two different documents. According to the FAA's student pilot certificate page, you're eligible if you're at least 16 years old (14 for gliders and balloons) and can read, speak, and understand English. You apply through the Integrated Airman Certification and Rating Application (IACRA) website or on paper using FAA Form 8710-1, and submit it through a Flight Standards District Office (FSDO), a designated pilot examiner, an airman certification representative at a part 141 flight school, or a flight instructor.

The FAA mails the certificate to you and says it takes approximately three weeks, with IACRA minimizing that time. Student pilot certificates issued after April 1, 2016 don't expire. Your instructor's solo endorsements go in your logbook, not on the certificate. When you fly solo, carry both your student pilot certificate and your medical certificate.

Your Pre-Exam Checklist

• Decide on your class: third class for private pilot training, or first class if you want to confirm you meet airline standards.
• Look up any condition or medication in the FAA AME Guide and get the records its Evaluation Data column lists, including a detailed progress note within 90 days if required.
• Check every medication, including over-the-counter ones, with the Medication Checker.
• Complete and submit MedXPress honestly, and save your confirmation number.
• Book an AME within 60 days of submitting, confirming Senior AME status for a first-class exam and asking about color vision testing.
• Bring your confirmation number, ID, glasses or contacts, medication list, and records.

For most student pilots, the first medical is a straightforward appointment. Prepare, answer honestly, and bring the right paperwork, and you give your AME the best chance to issue your certificate the same day.