Newtown Police Department
3 Main Street
Newtown, CT 06470
(203) 270-4255
Physical Ability Assessment
Medical Approval Form
To be filled in by physician:
This is to certify that I have reviewed the attached four elements of the Connecticut Police Officer Standards and Training Council’s Physical Ability Assessment. After reviewing said document, it is my professional opinion that the candidate named below:
Candidate’s Name:
Department Applying to: NEWTOWN POLICE DEPT.
CAN SAFELY PERFORM THE PHYSICAL ABILITY ASSESSMENT.
Physician’s Signature: Date:
(M.D. or D.O.)
Physician’s Name and Address (Type or Imprint With Office Stamp) 
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