June 20, 2011

MEPS medical questionnaire is used to acquire medical information that will be used during military recruitment at the Military Entrance Processing Station (MEPS). The MEPS medical questionnaire is filled up as part of the examination at MEPS. A physician asks the questions while conducting an interview with an individual in private. This may be based on family medical history or not. The MEPS medical questionnaire is used to acquire basic information about a person and recommend them on their medical fitness to join the military. It is used as a formality during recruitment. A sample MEPS medical questionnaire is below. Sample MEPS Medical Questionnaire Name _______________________________________

Address _______________________________

Tel Number __________________________________

Age ______________________________

Answer the following questions with Yes or No 1.Have you ever had any chest related complications? ______________________________________

2.Do you have any terminal diseases? ______________________________________________________________ 3.Do you have a problem with your joints? ______________________________________________________________ 4.Have you ever had any injuries on your body? ______________________________________________________________ 5.Do you have or ever had any recurrent pains on any part of your body? ______________________________________________________________ 6.Are you prone to fainting and convulsing? ______________________________________________________________ 7.Do you have any allergies? ______________________________________________________________ 8.Have you had any kind of surgery? ______________________________________________________________ 9.Have you had any psychiatric or psychological problem that required you to see a professional in these fields? ____________________________________________________________ Are you over 40 years old? _____________________________________________________________ Have been rejected by the military before for medical reasons? _____________________________________________________________ Have you been or had been bedwetting since 12 years old? _____________________________________________________________ Do you smoke? If yes, what type and how many cigarettes per day? _____________________________________________________________ Have you ever been evaluated, treated or hospitalized for substance abuse? _____________________________________________________________ Are you on any medication? ______________________________________________

Download MEPS Medical Questionnaire in Word Format

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