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FAA Medical Support for Pilots and AME's

 

Confidential FAA Sport Pilot Medical Practice Test

Sport Pilot Medical
Sport Pilot Rules

No information will be divulged to anyone without your consent.

This test is designed to identify areas which may jeopardize Sport Pilot eligibility. It should be used as a screening tool and is not intended as a substitute for a physicians examination or advice.  
Name  Optional
Age       Gender
E-mail Address Valid e-mail required
Phone Optional
 Has your state driving license or FAA medical been denied,                     
suspended or revoked?                
 

 

 

 

        If "YES", please give details below.
State of Residence
Date of last FAA medical application   Never applied

 

                   Medication

  Dosage  Condition Treated
Detail any loss of consciousness, injuries, major surgeries, or other condition which might limit physical activity or flying.

Select all below which applies (Explain in the box below)

Frequent or severe headaches
Eye or vision trouble
Hay fever or allergy
Asthma or lung disease
Stomach, liver, or intestinal trouble
Kidney stone or blood in urine
Neurological: epilepsy, seizures, stroke, etc
Mental disorders: depression, anxiety, etc
Dependence or use of illegal substance
Alcohol dependence, abuse or related convictions
Suicide attempt
Motion sickness requiring medication
Dizziness, fainting spells, or unconsciousness
EXPLAIN

 

 

Diabetes?

HEART HISTORY

Myocardial Infarction (Heart Attack)
Angina, bypass, angioplasty
Stroke / blood vessel surgery
Other heart condition    List
Blood Pressure

           

For a confidential FAA medical consultation
Call 800-699-4457

  

FAA Medical Certification and Aviation Medicine Support for pilots and aviation medical examiners.

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