Request to Participate in the NRCME Role Delineation Study (RDS)

As part of the preliminary research being conducted for development of the NRCME program, FMCSA is in the process of identifying 5,000 medical examiners who currently perform physical examinations for CMV drivers to complete a survey that will help define the role of the medical examiner. This includes 1,000 from each of the following professions: Advanced Practice Nurses, Doctors of Chiropractic, Doctors of Osteopathy, Medical Doctors, and Physician Assistants. If you currently perform these examinations, please volunteer to take part in this important survey by providing the information requested on this page. Please encourage your colleagues who perform CMV driver physical examinations to participate as well. The survey must be approved by the Office of Management and Budget (OMB), so a timeframe for distributing the survey has not yet been determined.

If you have previously volunteered to participate in the NRCME program, you do not need to submit your contact information again.

* The asterisk denotes a required field.

*	First Name
*	Last Name
*	Profession
*	Address1
	Address2
*	City
*	State
*	Zip
	Phone
*	Email

*		I perform the DOT physical and volunteer for the NRCME survey