Do you currently smoke?	YES	NO
	Do you exercise or perform other activity vigorously, at least 2 days per week, for at least 20 minutes?	YES	NO
	Are you within 20 pounds of your ideal weight? Calculate Ideal Weight	YES	NO
	Do you usually eat meals which are low in fat?	YES	NO
	Do you usually eat at least 2 servings of vegetables and 2 servings of fruit each day?	YES	NO
	Do you perform stretching or other exercises to prevent back problems at least 3 days per week?	YES	NO
	Do you see a physician each year for a comprehensive physical? (not FAA exam)	YES	NO
	Can you pass the IMSAFE check list?	YES	NO
	Do you get at least 8 hours of sleep each night and strive to go to bed and wake up at approximately the same time each day respectively?	YES	NO
	Is your blood pressure normal (below 140 / 90)? If unknown, answer no. What is a normal BP?	YES	NO