INSTRUCTIONS FOR PHYSICIAN
1. This medical certificate must be completed by an M.D. or D.O. only.
2. This examination is for a driver's racing competition license. At the end you will be asked to certify as follows:
I understand that the patient I have seen by telehealth appointment is requesting medical clearance to participate in NHRA Drag Racing, a high-speed motorsport. I understand that NHRA drag racing is strenuous, stressful, and includes all of the risks and dangers that face any highspeed vehicle racer. I hereby state and affirm that, to the best of my knowledge, through my telehealth exam, I am not aware of any physical or mental condition that I believe would affect the safety or wellbeing of the applicant, fellow competitors, spectators and others.
Based on my telehealth exam, this applicant:
is in good health and is physically and mentally able to participate in NHRA Drag Racing.
is free of physical and mental impairments that could be aggravated by participating in NHRA Drag Racing events, and/or which could place the applicant, competitors, spectators and others in attendance
in danger of harm.
is not subject to any of the following: fainting, loss of balance, hemophilia or any clotting disorder, loss of muscular coordination, seizures, psychosis, or impaired and uncorrected vision.
Should not participate in drag racing because of medical concerns that I have.
3. M.D. or D.O. must complete medical history information.
4. Record your medical findings.
5. This form to be completed in full. If unable to complete or obtain any findings, refer the patient to a second physician and attach any supplements.
6. M.D. or D.O. must sign this form.
7. Application and attachments must be in English.
8. Record of exam will be submitted to NHRA Electronically. The physician may print a copy for their office records before submission.
9. The patient/applicant will receive an email confirmation after submission by the physician with the required license application and instructions.