| Change 2023 vs 2025 | 2023 Pilot Question | 2023 Pilot Response Options | 2023 Display logic | 2025 Pilot Question | 2025 Pilot Response Options | 2025 Display logic | 2025 Trend | Notes |
| Terminology | Which best applies to you? (response required) | ™I applied for a Class I ™I applied for a Class II ™I applied for a Class III ™I submitted my BasicMed Comprehensive Medical Examination Checklist (CMEC) (Stop here and respond on the survey for BasicMed.) ™I have never applied for a pilot medical certificate. (Stop here and return your survey. Thank You!) |
Which best applies to you? (response required) | ™I applied for a Class I ™I applied for a Class II ™I applied for a Class III ™I submitted my BasicMed Comprehensive Medical Examination Checklist (CMEC) ™I have never applied for an airman medical certificate. |
Route out 'I Submitted my BasicMed Comprehensive Medical Examination Checklist (CMEC)' and 'I have never applied for an airman medical certificate' | 1 | Route out 'I Submitted my BasicMed Comprehensive Medical Examination Checklist (CMEC)' and 'I have never applied for an airman medical certificate' | |
| SAME | How many months ago did you submit your application? | ™0-3 months ™4-6 months ™7-9 months ™10-12 months ™13 months or more |
How many months ago did you submit your application? | ™0-3 months ™4-6 months ™7-9 months ™10-12 months ™13 months or more |
1 | |||
| SAME | How many miles did you travel one way for the exam appointment with your aviation medical examiner (AME)? | ™0-24 miles ™25-50 miles ™51-75 miles ™76-100 miles ™101 miles or more (explain below) |
How many miles did you travel one way for the exam appointment with your aviation medical examiner (AME)? | ™0-24 miles ™25-50 miles ™51-75 miles ™76-100 miles ™101 miles or more (explain below) |
1 | |||
| SAME | Reason(s) for traveling 101 miles or more for your appointment: | Open text | Display if '101 miles or more' is selected on item 3 | Reason(s) for traveling 101 miles or more for your appointment: | Open text | Display if '101 miles or more' is selected on item 3 | 0 | |
| SAME | How many AMEs did you contact before making your exam appointment? | ™1 ™2 ™3 ™4 ™5 or more |
How many AMEs did you contact before making your exam appointment? | ™1 ™2 ™3 ™4 ™5 or more |
1 | |||
| SAME | Is your AME your primary care doctor? | ™Yes ™No |
Is your AME your primary care doctor? | ™Yes ™No |
1 | |||
| Terminology | What was the cost of your examination for your pilot medical certification (excluding costs for any additional testing, evaluations or referrals recommended by the AME or required by the FAA)? | ™Less than $50 ™More than $50 but less than $100 Between $100 and $200 ™More than $200 |
What was the cost of your examination for your airman medical certification (excluding costs for any additional testing, evaluations or referrals recommended by the AME or required by the FAA)? | ™Less than $50 ™More than $50 but less than $100 Between $100 and $200 ™More than $200 |
1 | Terminology: pilot --> airman. |
||
| Terminology | How did you pay for your pilot medical certification examination only (excluding any additional testing, evaluations or referrals recommended by the AME or required by the FAA)? [mark all that apply] - Out of Pocket |
Mark all that apply |
How did you pay for your airman medical certification examination only (excluding any additional testing, evaluations or referrals recommended by the AME or required by the FAA)? [mark all that apply] - Out of Pocket |
Mark all that apply |
0 | New 2023 item now trendable 2023-2025 if requested. Terminology: pilot --> airman. |
||
| Terminology | How did you pay for your pilot medical certification examination only (excluding any additional testing, evaluations or referrals recommended by the AME or required by the FAA)? [mark all that apply] - Covered by employer |
Mark all that apply |
How did you pay for your airman medical certification examination only (excluding any additional testing, evaluations or referrals recommended by the AME or required by the FAA)? [mark all that apply] - Covered by employer |
Mark all that apply |
0 | New 2023 item now trendable 2023-2025 if requested. Terminology: pilot --> airman. |
||
| Terminology | How did you pay for your pilot medical certification examination only (excluding any additional testing, evaluations or referrals recommended by the AME or required by the FAA)? [mark all that apply] - Covered by health insurance |
Mark all that apply |
How did you pay for your airman medical certification examination only (excluding any additional testing, evaluations or referrals recommended by the AME or required by the FAA)? [mark all that apply] - Covered by health insurance |
Mark all that apply |
0 | New 2023 item now trendable 2023-2025 if requested. Terminology: pilot --> airman. |
||
| Terminology | How did you pay for your pilot medical certification examination only (excluding any additional testing, evaluations or referrals recommended by the AME or required by the FAA)? [mark all that apply] - Other (explain below) |
Mark all that apply |
How did you pay for your airman medical certification examination only (excluding any additional testing, evaluations or referrals recommended by the AME or required by the FAA)? [mark all that apply] - Other (explain below) |
Mark all that apply |
0 | New 2023 item now trendable 2023-2025 if requested. Terminology: pilot --> airman. |
||
| SAME | Other: | Open text | Dijsplay if 'Other (explain below)' is selected on item 7 | Other: | Open text | Display if 'Other (explain below)' is selected on item 7 | 0 | Terminology: pilot --> airman. |
| Terminology | Did you have any additional requirements associated with your pilot medical certification examination (e.g., additional testing, evaluations, or referrals recommended by the AME or required by the FAA)? | Yes No |
Did you have any additional requirements associated with your airman medical certification examination (e.g., additional testing, evaluations, or referrals recommended by the AME or required by the FAA)? | Yes No |
0 | New 2023 item now trendable 2023-2025 if requested. Terminology: pilot --> airman. |
||
| Terminology | What was the approximate total cost for all additional requirements associated with your pilot medical certification examination (e.g., additional testing, evaluations or referrals recommended by the AME or required by the FAA)? | ™Less than $1000 ™$1000 but less than $5000 ™$5000 but less than $10,000 ™$10,000 but less than $15,000 ™$15,000 but less than $20,000 ™$20,000 but less than $25,000 ™More than $25,000 |
What was the approximate total cost for all additional requirements associated with your airman medical certification examination (e.g., additional testing, evaluations or referrals recommended by the AME or required by the FAA)? | ™Less than $1000 ™$1000 but less than $5000 ™$5000 but less than $10,000 ™$10,000 but less than $15,000 ™$15,000 but less than $20,000 ™$20,000 but less than $25,000 ™More than $25,000 |
Display if 'Yes' is selected on item 8 | 0 | New 2023 item now trendable 2023-2025 if requested. Terminology: pilot --> airman. |
|
| SAME | How did you pay for any additional testing, evaluations, or referrals recommended by the AME or required by the FAA (excluding the exam)? [mark all that apply] - Did not do additional testing due to cost |
Mark all that apply |
How did you pay for any additional testing, evaluations, or referrals recommended by the AME or required by the FAA (excluding the exam)? [mark all that apply] - Did not do additional testing due to cost |
Mark all that apply |
Display if 'Yes' is selected on item 8 | 0 | New 2023 item now trendable 2023-2025 if requested. Terminology: pilot --> airman. |
|
| SAME | How did you pay for any additional testing, evaluations or referrals recommended by the AME or required by the FAA (excluding the exam)? [mark all that apply] - Out of Pocket |
Mark all that apply |
How did you pay for any additional testing, evaluations or referrals recommended by the AME or required by the FAA (excluding the exam)? [mark all that apply] - Out of Pocket |
Mark all that apply |
0 | New 2023 item now trendable 2023-2025 if requested. Terminology: pilot --> airman. |
||
| SAME | How did you pay for any additional testing, evaluations or referrals recommended by the AME or required by the FAA (excluding the exam)? [mark all that apply] - Covered by employer |
Mark all that apply |
How did you pay for any additional testing, evaluations or referrals recommended by the AME or required by the FAA (excluding the exam)? [mark all that apply] - Covered by employer |
Mark all that apply |
0 | New 2023 item now trendable 2023-2025 if requested. Terminology: pilot --> airman. |
||
| SAME | How did you pay for any additional testing, evaluations or referrals recommended by the AME or required by the FAA (excluding the exam)? [mark all that apply] - Covered by health insurance |
Mark all that apply |
How did you pay for any additional testing, evaluations or referrals recommended by the AME or required by the FAA (excluding the exam)? [mark all that apply] - Covered by health insurance |
Mark all that apply |
0 | New 2023 item now trendable 2023-2025 if requested. Terminology: pilot --> airman. |
||
| SAME | How did you pay for any additional testing, evaluations or referrals recommended by the AME or required by the FAA (excluding the exam)? [mark all that apply] - Other (explain below) |
Mark all that apply |
How did you pay for any additional testing, evaluations or referrals recommended by the AME or required by the FAA (excluding the exam)? [mark all that apply] - Other (explain below) |
Mark all that apply |
0 | New 2023 item now trendable 2023-2025 if requested. Terminology: pilot --> airman. |
||
| SAME | Other: | Open text | Display if 'Other (explain below)' is selected on item 10 | Other: | Open text | Display if 'Other (explain below)' is selected on item 10 | 0 | |
| SAME | What was the basis for selecting your AME? [mark all that apply] - Referred by flight instructor or school |
Mark all that apply | What was the basis for selecting your AME? [mark all that apply] - Referred by flight instructor or school |
Mark all that apply | 1 | |||
| SAME | What was the basis for selecting your AME? [mark all that apply] - Referred by airline or AME employed by airline |
Mark all that apply | What was the basis for selecting your AME? [mark all that apply] - Referred by airline or AME employed by airline |
Mark all that apply | 1 | |||
| SAME | What was the basis for selecting your AME? [mark all that apply] - Referred by pilot |
Mark all that apply | What was the basis for selecting your AME? [mark all that apply] - Referred by pilot |
Mark all that apply | 1 | |||
| SAME | What was the basis for selecting your AME? [mark all that apply] - Referred by doctor or previous AME |
Mark all that apply | What was the basis for selecting your AME? [mark all that apply] - Referred by doctor or previous AME |
Mark all that apply | 1 | |||
| SAME | What was the basis for selecting your AME? [mark all that apply] - Performed my previous medical certification exam(s) |
Mark all that apply | What was the basis for selecting your AME? [mark all that apply] - Performed my previous medical certification exam(s) |
Mark all that apply | 1 | |||
| SAME | What was the basis for selecting your AME? [mark all that apply] - Is my primary care doctor |
Mark all that apply | What was the basis for selecting your AME? [mark all that apply] - Is my primary care doctor |
Mark all that apply | 1 | |||
| SAME | What was the basis for selecting your AME? [mark all that apply] - Makes quick certification decisions |
Mark all that apply | What was the basis for selecting your AME? [mark all that apply] - Makes quick certification decisions |
Mark all that apply | 1 | |||
| SAME | What was the basis for selecting your AME? [mark all that apply] - Licensed to perform needed service (Class I exam, special issuance, etc.) |
Mark all that apply | What was the basis for selecting your AME? [mark all that apply] - Licensed to perform needed service (Class I exam, special issuance, etc.) |
Mark all that apply | 1 | |||
| SAME | What was the basis for selecting your AME? [mark all that apply] - Handles complex cases |
Mark all that apply | What was the basis for selecting your AME? [mark all that apply] - Handles complex cases |
Mark all that apply | 1 | |||
| SAME | What was the basis for selecting your AME? [mark all that apply] - Nearest location |
Mark all that apply | What was the basis for selecting your AME? [mark all that apply] - Nearest location |
Mark all that apply | 1 | |||
| SAME | What was the basis for selecting your AME? [mark all that apply] - Earliest available appointment |
Mark all that apply | What was the basis for selecting your AME? [mark all that apply] - Earliest available appointment |
Mark all that apply | 1 | |||
| SAME | What was the basis for selecting your AME? [mark all that apply] - Low cost |
Mark all that apply | What was the basis for selecting your AME? [mark all that apply] - Low cost |
Mark all that apply | 1 | |||
| SAME | What was the basis for selecting your AME? [mark all that apply] - Other reason(s) (explain below) |
Mark all that apply | What was the basis for selecting your AME? [mark all that apply] - Other reason(s) (explain below) |
Mark all that apply | 1 | |||
| SAME | Other reason(s) for selecting your AME: | Open text | Display question if 'Other reason(s) (explain below)' was selected for item 11 | Other reason(s) for selecting your AME: | Open text | Display question if 'Other reason(s) (explain below)' was selected for item 11 | 0 | |
| SAME | Did the AME’s office tell you to bring the following to your exam appointment? - Valid photo ID |
Yes No, but did need for exam No, not needed for exam Do not remember (Valid - not recoded out) Not applicable |
Did the AME’s office tell you to bring the following to your exam appointment? - Valid photo ID |
Yes No, but did need for exam No, not needed for exam Do not remember Not applicable |
1 | Response option 'Do not remember' is valid - not recoded out. | ||
| SAME | Did the AME’s office tell you to bring the following to your exam appointment? - MedXPress confirmation number |
Yes No, but did need for exam No, not needed for exam Do not remember (Valid - not recoded out) Not applicable |
Did the AME’s office tell you to bring the following to your exam appointment? - MedXPress confirmation number |
Yes No, but did need for exam No, not needed for exam Do not remember Not applicable |
1 | Response option 'Do not remember' is valid - not recoded out. | ||
| SAME | Did the AME’s office tell you to bring the following to your exam appointment? - Printout of completed Summary Sheet from MedXPress |
Yes No, but did need for exam No, not needed for exam Do not remember (Valid - not recoded out) Not applicable |
Did the AME’s office tell you to bring the following to your exam appointment? - Printout of completed Summary Sheet from MedXPress |
Yes No, but did need for exam No, not needed for exam Do not remember Not applicable |
1 | Response option 'Do not remember' is valid - not recoded out. | ||
| SAME | Did the AME’s office tell you to bring the following to your exam appointment? - List of your medications |
Yes No, but did need for exam No, not needed for exam Do not remember (Valid - not recoded out) Not applicable |
Did the AME’s office tell you to bring the following to your exam appointment? - List of your medications |
Yes No, but did need for exam No, not needed for exam Do not remember Not applicable |
1 | Response option 'Do not remember' is valid - not recoded out. | ||
| SAME | Did the AME’s office tell you to bring the following to your exam appointment? - Medical history details (e.g., dates of hospitalizations and medical exams) |
Yes No, but did need for exam No, not needed for exam Do not remember (Valid - not recoded out) Not applicable |
Did the AME’s office tell you to bring the following to your exam appointment? - Medical history details (e.g., dates of hospitalizations and medical exams) |
Yes No, but did need for exam No, not needed for exam Do not remember Not applicable |
1 | Response option 'Do not remember' is valid - not recoded out. | ||
| SAME | Did the AME’s office tell you to bring the following to your exam appointment? - Current medical tests/lab results |
Yes No, but did need for exam No, not needed for exam Do not remember (Valid - not recoded out) Not applicable |
Did the AME’s office tell you to bring the following to your exam appointment? - Current medical tests/lab results |
Yes No, but did need for exam No, not needed for exam Do not remember Not applicable |
1 | Response option 'Do not remember' is valid - not recoded out. | ||
| SAME | Did the AME’s office tell you to bring the following to your exam appointment? - Past medical tests/lab results |
Yes No, but did need for exam No, not needed for exam Do not remember (Valid - not recoded out) Not applicable |
Did the AME’s office tell you to bring the following to your exam appointment? - Past medical tests/lab results |
Yes No, but did need for exam No, not needed for exam Do not remember Not applicable |
1 | Response option 'Do not remember' is valid - not recoded out. | ||
| SAME | Did the AME’s office tell you to bring the following to your exam appointment? - Records from medical or mental health evaluations, hospitalizations, etc. |
Yes No, but did need for exam No, not needed for exam Do not remember (Valid - not recoded out) Not applicable |
Did the AME’s office tell you to bring the following to your exam appointment? - Records from medical or mental health evaluations, hospitalizations, etc. |
Yes No, but did need for exam No, not needed for exam Do not remember Not applicable |
1 | Response option 'Do not remember' is valid - not recoded out. | ||
| SAME | Did the AME’s office tell you to bring the following to your exam appointment? - Special Issuance Authorization paperwork |
Yes No, but did need for exam No, not needed for exam Do not remember (Valid - not recoded out) Not applicable |
Did the AME’s office tell you to bring the following to your exam appointment? - Special Issuance Authorization paperwork |
Yes No, but did need for exam No, not needed for exam Do not remember Not applicable |
1 | Response option 'Do not remember' is valid - not recoded out. | ||
| SAME | Did the AME’s office tell you to bring the following to your exam appointment? - SODA (statement of demonstrated ability) paperwork |
Yes No, but did need for exam No, not needed for exam Do not remember (Valid - not recoded out) Not applicable |
Did the AME’s office tell you to bring the following to your exam appointment? - SODA (statement of demonstrated ability) paperwork |
Yes No, but did need for exam No, not needed for exam Do not remember Not applicable |
1 | Response option 'Do not remember' is valid - not recoded out. | ||
| SAME | Did the AME’s office tell you to bring the following to your exam appointment? - Conditions AMEs Can Issue (CACI) paperwork |
Yes No, but did need for exam No, not needed for exam Do not remember (Valid - not recoded out) Not applicable |
Did the AME’s office tell you to bring the following to your exam appointment? - Conditions AMEs Can Issue (CACI) paperwork |
Yes No, but did need for exam No, not needed for exam Do not remember Not applicable |
1 | Response option 'Do not remember' is valid - not recoded out. | ||
| SAME | Did you use MedXPress to submit your application? (response required) | Yes No (answer item 14, then skip to item 23, on page 5) Do not remember (answer item 14, then skip to item 23, on page 5) |
Did you use MedXPress to submit your application? (response required) | Yes No (answer item 14, then skip to item 23, on page 5) Do not remember (answer item 14, then skip to item 23, on page 5) |
1 | |||
| SAME | Did you use a computer to answer FAA medical application questions? | ™Yes ™No ™Do not remember |
Display question if 'No' or 'Do not remember' on item 13 | Did you use a computer to answer FAA medical application questions? | ™Yes ™No ™Do not remember |
Display question if 'No' or 'Do not remember' on item 13 | 1 | |
| SAME | Did your AME’s office ask you to provide your MedXPress Summary Sheet before your exam appointment? (response required) | ™Yes ™No (skip to item 17, on the next page) ™Do not remember (skip to item 17, on the next page) |
Display question if 'Yes' on item 13 | Did your AME’s office ask you to provide your MedXPress Summary Sheet before your exam appointment? (response required) | ™Yes ™No ™Do not remember |
Display question if 'Yes' on item 13 | 1 | |
| SAME | Based on their receipt of your MedXPress Summary Sheet, did your AME’s office ask you to bring additional documentation to your exam appointment? | ™Yes ™No ™Do not remember (Valid - not recoded out) |
Display question if 'Yes' on item 15 | Based on their receipt of your MedXPress Summary Sheet, did your AME’s office ask you to bring additional documentation to your exam appointment? | ™Yes ™No ™Do not remember |
Display question if 'Yes' on item 15 | 1 | Response option 'Do not remember' is valid - not recoded out. |
| SAME | Overall how satisfied were you with the performance of MedXPress? | ™Very dissatisfied (explain below) ™Dissatisfied (explain below) ™Neither dissatisfied nor satisfied ™Satisfied ™Very satisfied |
Display question if 'Yes' on item 13 | Overall how satisfied were you with the performance of MedXPress? | ™Very dissatisfied ™Dissatisfied ™Neither dissatisfied nor satisfied ™Satisfied ™Very satisfied |
Display question if 'Yes' on item 13 | 1 | |
| SAME | Please explain why you were dissatisfied with the performance of MedXPress: | Open text | Display question if 'dissatisfied (explain below)' or 'very dissatisfied (explain below)' on item 17 | Please explain why you were dissatisfied with the performance of MedXPress: | Open text | Display question if 'dissatisfied (explain below)' or 'very dissatisfied (explain below)' on item 17 | 0 | |
| SAME | How did MedXPress perform compared to your expectations? | ™Far below expectations (explain below) ™Below expectations (explain below) ™Met expectations ™Above expectations ™Far above expectations |
Display question if 'Yes' on item 13 | How did MedXPress perform compared to your expectations? | ™Far below expectations ™Below expectations ™Met expectations ™Above expectations ™Far above expectations |
Display question if 'Yes' on item 13 | 1 | |
| SAME | Please explain why MedXPress performed below your expectations: | Open text | Please explain why MedXPress performed below your expectations: | Open text | Display question if 'dissatisfied (explain below)' or 'very dissatisfied (explain below)' on item 18 | 0 | ||
| SAME | Overall how would you rate the performance of MedXPress? | ™Very poor ™Poor ™Average ™Good ™Excellent |
Display question if 'Yes' on item 13 | Overall how would you rate the performance of MedXPress? | ™Very poor ™Poor ™Average ™Good ™Excellent |
Display question if 'Yes' on item 13 | 1 | |
| SAME | If you could electronically attach/upload supporting documents to your MedXPress account, would you do so? | ™Yes ™No ™No, I would still have my AME do it |
Display question if 'Yes' on item 13 | If you could electronically attach/upload supporting documents to your MedXPress account, would you do so? | ™Yes ™No ™No, I would still have my AME do it |
Display question if 'Yes' on item 13 | 1 | |
| SAME | Did the AME access your MedXPress form online during the exam appointment? (response required) | ™Yes (skip to item 23, on the next page) ™No ™Do not know (skip to item 23 on the next page) ™Do not remember (skip to item 23 on the next page) (Valid - not recoded out) |
Display question if 'Yes' on item 13 | Did the AME access your MedXPress form online during the exam appointment? (response required) | ™Yes ™No ™Do not know ™Do not remember |
Display question if 'Yes' on item 13 | 1 | Response option 'Do not remember' is valid - not recoded out. |
| SAME | What are the reasons the AME did not access your MedXPress form online during the exam appointment? [mark all that apply] - I did not have my confirmation number |
Mark all that apply | Display question if 'No' on item 21 | What are the reasons the AME did not access your MedXPress form online during the exam appointment? [mark all that apply] - I did not have my confirmation number |
Mark all that apply | Display question if 'No' on item 21 | 1 | |
| SAME | What are the reasons the AME did not access your MedXPress form online during the exam appointment? [mark all that apply] - My confirmation number had expired |
Mark all that apply | Display question if 'No' on item 21 | What are the reasons the AME did not access your MedXPress form online during the exam appointment? [mark all that apply] - My confirmation number had expired |
Mark all that apply | Display question if 'No' on item 21 | 1 | |
| SAME | What are the reasons the AME did not access your MedXPress form online during the exam appointment? [mark all that apply] - The AME did not require MedXPress |
Mark all that apply | Display question if 'No' on item 21 | What are the reasons the AME did not access your MedXPress form online during the exam appointment? [mark all that apply] - The AME did not require MedXPress |
Mark all that apply | Display question if 'No' on item 21 | 1 | |
| SAME | What are the reasons the AME did not access your MedXPress form online during the exam appointment? [mark all that apply] - Other reason (explain below) |
Mark all that apply | Display question if 'No' on item 21 | What are the reasons the AME did not access your MedXPress form online during the exam appointment? [mark all that apply] - Other reason (explain below) |
Mark all that apply | Display question if 'No' on item 21 | 1 | |
| SAME | Other reason the AME did not access your MedXPress form online during the exam appointment: | Open text | Display question if 'Other reason (explain later)' is selected for item 22 | Other reason the AME did not access your MedXPress form online during the exam appointment: | Open text | Display question if 'Other reason (explain later)' is selected for item 22 | 0 | |
| SAME | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Reviewed your medical history with you - No one |
Mark all that apply | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Reviewed your medical history with you - No one |
Mark all that apply | 1 | |||
| SAME | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Reviewed your medical history with you - AME |
Mark all that apply | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Reviewed your medical history with you - AME |
Mark all that apply | 1 | |||
| SAME | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Reviewed your medical history with you - Another physician (not the AME) |
Mark all that apply | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Reviewed your medical history with you - Another physician (not the AME) |
Mark all that apply | 1 | |||
| SAME | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Reviewed your medical history with you - Physician’s Assistant |
Mark all that apply | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Reviewed your medical history with you - Physician’s Assistant |
Mark all that apply | 1 | |||
| SAME | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Reviewed your medical history with you - Nurse |
Mark all that apply | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Reviewed your medical history with you - Nurse |
Mark all that apply | 1 | |||
| SAME | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Reviewed your medical history with you - Other office personnel |
Mark all that apply | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Reviewed your medical history with you - Other office personnel |
Mark all that apply | 1 | |||
| SAME | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Reviewed your medical history with you - Do not remember |
Mark all that apply | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Reviewed your medical history with you - Do not remember |
Mark all that apply | 1 | |||
| SAME | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Performed your physical exam - No one |
Mark all that apply | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Performed your physical exam - No one |
Mark all that apply | 1 | |||
| SAME | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Performed your physical exam - AME |
Mark all that apply | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Performed your physical exam - AME |
Mark all that apply | 1 | |||
| SAME | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Performed your physical exam - Another physician (not the AME) |
Mark all that apply | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Performed your physical exam - Another physician (not the AME) |
Mark all that apply | 1 | |||
| SAME | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Performed your physical exam - Physician’s Assistant |
Mark all that apply | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Performed your physical exam - Physician’s Assistant |
Mark all that apply | 1 | |||
| SAME | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Performed your physical exam - Nurse |
Mark all that apply | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Performed your physical exam - Nurse |
Mark all that apply | 1 | |||
| SAME | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Performed your physical exam - Other office personnel |
Mark all that apply | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Performed your physical exam - Other office personnel |
Mark all that apply | 1 | |||
| SAME | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Performed your physical exam - Do not remember |
Mark all that apply | During your exam appointment, who did each of the following: (response required) [mark all that apply] - Performed your physical exam - Do not remember |
Mark all that apply | 1 | |||
| SAME | To what extent did your AME do each of the following during your exam appointment? - Obtain a comprehensive history |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 | To what extent did your AME do each of the following during your exam appointment? - Obtain a comprehensive history |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 (i.e., 23_1 or 23_2) | 1 | |
| SAME | To what extent did your AME do each of the following during your exam appointment? - Discuss safety risk(s) of current medical condition(s) |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 | To what extent did your AME do each of the following during your exam appointment? - Discuss safety risk(s) of current medical condition(s) |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 (i.e., 23_1 or 23_2) | 1 | |
| SAME | To what extent did your AME do each of the following during your exam appointment? - Explain the certification process and airman appeal rights |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 | To what extent did your AME do each of the following during your exam appointment? - Explain the certification process and airman appeal rights |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 (i.e., 23_1 or 23_2) | 1 | |
| SAME | To what extent did your AME do each of the following during your exam appointment? - Discuss safety risk of over-the-counter (OTC) medications and supplements |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 | To what extent did your AME do each of the following during your exam appointment? - Discuss safety risk of over-the-counter (OTC) medications and supplements |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 (i.e., 23_1 or 23_2) | 1 | |
| SAME | To what extent did your AME do each of the following during your exam appointment? - Discuss mental health |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 | To what extent did your AME do each of the following during your exam appointment? - Discuss mental health |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 (i.e., 23_1 or 23_2) | 1 | |
| SAME | To what extent did your AME do each of the following during your exam appointment? - Discuss sleep patterns |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 | To what extent did your AME do each of the following during your exam appointment? - Discuss sleep patterns |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 (i.e., 23_1 or 23_2) | 1 | |
| SAME | Did your AME... - perform a thorough medical exam? |
™Yes ™No |
Display question if 'AME' performed your physical exam on item 23 | Did your AME... - perform a thorough medical exam? |
™Yes ™No |
Display question if 'AME' performed your physical exam on item 23 (i.e., 23_2) | 1 | |
| SAME | Did your AME... - examine your eyes and ears with a medical device? |
™Yes ™No |
Display question if 'AME' performed your physical exam on item 23 | Did your AME... - examine your eyes and ears with a medical device? |
™Yes ™No |
Display question if 'AME' performed your physical exam on item 23 (i.e., 23_2) | 1 | |
| SAME | Did your AME... - have you remove or undo articles of clothing for the exam? |
™Yes ™No |
Display question if 'AME' performed your physical exam on item 23 | Did your AME... - have you remove or undo articles of clothing for the exam? |
™Yes ™No |
Display question if 'AME' performed your physical exam on item 23 (i.e., 23_2) | 1 | |
| SAME | Did your AME... - listen to your heart and lungs? |
™Yes ™No |
Display question if 'AME' performed your physical exam on item 23 | Did your AME... - listen to your heart and lungs? |
™Yes ™No |
Display question if 'AME' performed your physical exam on item 23 (i.e., 23_2) | 1 | |
| SAME | To what extent did your AME… - provide a professional setting for the medical exam, including cleanliness and appearance? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 | To what extent did your AME… - provide a professional setting for the medical exam, including cleanliness and appearance? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 (i.e., 23_1 or 23_2) | 1 | |
| SAME | To what extent did your AME… - charge appropriately for services? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 | To what extent did your AME… - charge appropriately for services? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 (i.e., 23_1 or 23_2) | 1 | |
| SAME | To what extent did your AME… - clearly explain your responsibilities in the medical certification process? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 | To what extent did your AME… - clearly explain your responsibilities in the medical certification process? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 (i.e., 23_1 or 23_2) | 1 | |
| SAME | To what extent did your AME... - provide you with all the information you requested? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 | To what extent did your AME... - provide you with all the information you requested? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 (i.e., 23_1 or 23_2) | 1 | |
| SAME | To what extent did your AME… - provide information you requested in a timely manner? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 | To what extent did your AME… - provide information you requested in a timely manner? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 (i.e., 23_1 or 23_2) | 1 | |
| SAME | To what extent did your AME... - provide you with accurate information? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 | To what extent did your AME... - provide you with accurate information? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 (i.e., 23_1 or 23_2) | 1 | |
| SAME | To what extent did your AME… - treat you with courtesy and respect? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 | To what extent did your AME… - treat you with courtesy and respect? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'AME' on item 23 (i.e., 23_1 or 23_2) | 1 | |
| SAME | Indicate why you responded ‘Not at all’ or ‘Limited’ for extent AME provided a professional setting for your exam. [mark all that apply] - Nonmedical setting (home, hangar) |
Mark all that apply | Display question if 'Not at all' or 'Limited extent' on item 26 | Indicate why you responded ‘Not at all’ or ‘Limited’ for extent AME provided a professional setting for your exam. [mark all that apply] - Nonmedical setting (home, hangar) |
Mark all that apply | Display question if 'Not at all' or 'Limited extent' on item 26 | 1 | |
| SAME | Indicate why you responded ‘Not at all’ or ‘Limited’ for extent AME provided a professional setting for your exam. [mark all that apply] - Unclean or unkempt setting |
Mark all that apply | Display question if 'Not at all' or 'Limited extent' on item 26 | Indicate why you responded ‘Not at all’ or ‘Limited’ for extent AME provided a professional setting for your exam. [mark all that apply] - Unclean or unkempt setting |
Mark all that apply | Display question if 'Not at all' or 'Limited extent' on item 26 | 1 | |
| SAME | Indicate why you responded ‘Not at all’ or ‘Limited’ for extent AME provided a professional setting for your exam. [mark all that apply] - No privacy |
Mark all that apply | Display question if 'Not at all' or 'Limited extent' on item 26 | Indicate why you responded ‘Not at all’ or ‘Limited’ for extent AME provided a professional setting for your exam. [mark all that apply] - No privacy |
Mark all that apply | Display question if 'Not at all' or 'Limited extent' on item 26 | 1 | |
| SAME | Indicate why you responded ‘Not at all’ or ‘Limited’ for extent AME provided a professional setting for your exam. [mark all that apply] - Other reason(s) (explain below) |
Mark all that apply | Display question if 'Not at all' or 'Limited extent' on item 26 | Indicate why you responded ‘Not at all’ or ‘Limited’ for extent AME provided a professional setting for your exam. [mark all that apply] - Other reason(s) (explain below) |
Mark all that apply | Display question if 'Not at all' or 'Limited extent' on item 26 | 1 | |
| SAME | Other reason(s) for your response: | Open text | Display question if 'Other reason(s) (explain below)' is selected | Other reason(s) for your response: | Open text | Display question if 'Other reason(s) (explain below)' is selected | 0 | |
| SAME | During your most recent medical certification exam, did your AME identify oralert you to any new medical condition(s) that may or may not need to be evaluated by your primary care physician? (response required) | ™Yes No |
If 'No' is selected, skip to item 30 | During your most recent medical certification exam, did your AME identify oralert you to any new medical condition(s) that may or may not need to be evaluated by your primary care physician? (response required) | ™Yes No |
1 | ||
| SAME | Did the new health condition(s) require treatment for medical certification? | Yes No |
Display question if 'Yes' on item 28 | Did the new health condition(s) require treatment for medical certification? | Yes No |
Display question if 'Yes' on item 28 | 1 | |
| SAME | During your most recent medical certification exam, did your AME identify or alert you that a previously existing health condition(s) required treatment to obtain your medical certification? (response required) | ™Yes No |
if 'No' is selected, skip to item 32 | During your most recent medical certification exam, did your AME identify or alert you that a previously existing health condition(s) required treatment to obtain your medical certification? (response required) | ™Yes No |
1 | ||
| SAME | Did you receive treatment for the previously existing health condition(s)? | Yes No |
Display question if 'Yes' on item 30 | Did you receive treatment for the previously existing health condition(s)? | Yes No |
Display question if 'Yes' on item 30 | 1 | |
| SAME | During any previous medical certification exam, did your AME alert you to any new medical condition(s) that may or may not have required evaluation from your primary care physician? (response required) | Yes No (skip to item 34) |
If 'No' is selected, skip to item 34 | During any previous medical certification exam, did your AME alert you to any new medical condition(s) that may or may not have required evaluation from your primary care physician? (response required) | Yes No |
1 | ||
| SAME | Did the new health condition(s) require treatment for medical certification? | ™Yes No |
Display question if 'Yes' on item 32 | Did the new health condition(s) require treatment for medical certification? | ™Yes No |
Display question if 'Yes' on item 32 | 1 | |
| SAME | During any previous medical certification exam, did your AME alert you that a previously existing health condition(s) required treatment to obtain your medical certification? (response required) | ™Yes No (skip to item 36, on the next page) |
If 'No' is selected, skip to item 36 | During any previous medical certification exam, did your AME alert you that a previously existing health condition(s) required treatment to obtain your medical certification? (response required) | ™Yes No |
1 | ||
| SAME | Did you receive treatment for the previously existing health condition(s)? | ™Yes No |
Display question if 'Yes' on item 34 | Did you receive treatment for the previously existing health condition(s)? | ™Yes No |
Display question if 'Yes' on item 34 | 1 | |
| SAME | Overall how satisfied were you with your exam appointment? (response required) | ™Very dissatisfied ™Dissatisfied ™Neither dissatisfied nor satisfied ™Satisfied ™Very satisfied |
If 'Neither dissatisfied nor satisfied,' 'Satisfied,' or 'Very satisfied' is selected, skip to item 38 | Overall how satisfied were you with your exam appointment? (response required) | ™Very dissatisfied ™Dissatisfied ™Neither dissatisfied nor satisfied ™Satisfied ™Very satisfied |
1 | ||
| SAME | Why were you dissatisfied with your exam appointment? [mark all that apply] - AME did not issue my certificate during the exam appointment |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | Why were you dissatisfied with your exam appointment? [mark all that apply] - AME did not issue my certificate during the exam appointment |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | 1 | |
| SAME | Why were you dissatisfied with your exam appointment? [mark all that apply] - The exam was not thorough |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | Why were you dissatisfied with your exam appointment? [mark all that apply] - The exam was not thorough |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | 1 | |
| SAME | Why were you dissatisfied with your exam appointment? [mark all that apply] - Not examined in a professional environment |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | Why were you dissatisfied with your exam appointment? [mark all that apply] - Not examined in a professional environment |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | 1 | |
| SAME | Why were you dissatisfied with your exam appointment? [mark all that apply] - AME conducted the exam at a different location than listed in the FAA directory |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | Why were you dissatisfied with your exam appointment? [mark all that apply] - AME conducted the exam at a different location than listed in the FAA directory |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | 1 | |
| SAME | Why were you dissatisfied with your exam appointment? [mark all that apply] - I had to remove articles of clothing |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | Why were you dissatisfied with your exam appointment? [mark all that apply] - I had to remove articles of clothing |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | 1 | |
| SAME | Why were you dissatisfied with your exam appointment? [mark all that apply] - Not treated with courtesy and respect |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | Why were you dissatisfied with your exam appointment? [mark all that apply] - Not treated with courtesy and respect |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | 1 | |
| SAME | Why were you dissatisfied with your exam appointment? [mark all that apply] - Cost of the basic certification examination only |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | Why were you dissatisfied with your exam appointment? [mark all that apply] - Cost of the basic certification examination only |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | 1 | |
| SAME | Why were you dissatisfied with your exam appointment? [mark all that apply] - Cost of additional items required by the AME and/or the FAA |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | Why were you dissatisfied with your exam appointment? [mark all that apply] - Cost of additional items required by the AME and/or the FAA |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | 1 | |
| SAME | Why were you dissatisfied with your exam appointment? [mark all that apply] - Other reason(s) (explain below) |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | Why were you dissatisfied with your exam appointment? [mark all that apply] - Other reason(s) (explain below) |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 36 | 1 | |
| SAME | Other reason(s) you were dissatisfied with your exam appointment: | Open text | Display question if 'Other reason(s) (explain below)' is selected on item 37 | Other reason(s) you were dissatisfied with your exam appointment: | Open text | Display question if 'Other reason(s) (explain below)' is selected on item 37 | 0 | |
| SAME | Overall how satisfied were you with the quality of service provided by your AME? (response required) | ™Very dissatisfied ™Dissatisfied ™Neither dissatisfied nor satisfied ™Satisfied ™Very satisfied |
If 'Neither dissatisfied nor satisfied,' 'Satisfied,' or 'Very satisfied' is selected, skip to item 40 | Overall how satisfied were you with the quality of service provided by your AME? (response required) | ™Very dissatisfied ™Dissatisfied ™Neither dissatisfied nor satisfied ™Satisfied ™Very satisfied |
1 | ||
| SAME | Why were you dissatisfied with the quality of AME services? [mark all that apply] - AME did not issue my certificate during the exam appointment |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 38 | Why were you dissatisfied with the quality of AME services? [mark all that apply] - AME did not issue my certificate during the exam appointment |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 38 | 1 | |
| Terminology | Why were you dissatisfied with the quality of AME services? [mark all that apply] - AME lacked knowledge of current pilot medical certification standards |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 38 | Why were you dissatisfied with the quality of AME services? [mark all that apply] - AME lacked knowledge of current airman medical certification standards |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 38 | 1 | Terminology: pilot --> airman. |
| SAME | Why were you dissatisfied with the quality of AME services? [mark all that apply] - Not informed of required documentation to bring to the exam |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 38 | Why were you dissatisfied with the quality of AME services? [mark all that apply] - Not informed of required documentation to bring to the exam |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 38 | 1 | |
| SAME | Why were you dissatisfied with the quality of AME services? [mark all that apply] - Not informed of additional documentation that the FAA would require to issue my certificate |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 38 | Why were you dissatisfied with the quality of AME services? [mark all that apply] - Not informed of additional documentation that the FAA would require to issue my certificate |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 38 | 1 | |
| SAME | Why were you dissatisfied with the quality of AME services? [mark all that apply] - Not informed of status of my application |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 38 | Why were you dissatisfied with the quality of AME services? [mark all that apply] - Not informed of status of my application |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 38 | 1 | |
| SAME | Why were you dissatisfied with the quality of AME services? [mark all that apply] - Refused to offer any assistance beyond performing the exam |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 38 | Why were you dissatisfied with the quality of AME services? [mark all that apply] - Refused to offer any assistance beyond performing the exam |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 38 | 1 | |
| SAME | Why were you dissatisfied with the quality of AME services? [mark all that apply] - Other reason(s) (explain below) |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 38 | Why were you dissatisfied with the quality of AME services? [mark all that apply] - Other reason(s) (explain below) |
Mark all that apply | Display question if 'Very dissatisfied' or 'Dissatisfied' on item 38 | 1 | |
| SAME | Other reason(s) you were dissatisfied with the quality of AME services: | Open text | Display question if 'Other reason(s) (explain below)' on item 39 | Other reason(s) you were dissatisfied with the quality of AME services: | Open text | Display question if 'Other reason(s) (explain below)' on item 39 | 0 | |
| Terminology | Based on your most recent experience with your AME, to what extent does the FAA pilot medical certification process ensure the safety of the National Airspace System? (response required) | ™Not at all ™Limited extent ™Moderate extent ™Considerable extent (skip to item 42) ™Great extent (skip to item 42) |
If 'Considerable extent' and 'Great extent' were selected, skip to item 42 | Based on your most recent experience with your AME, to what extent does the FAA airman medical certification process ensure the safety of the National Airspace System? (response required) | ™Not at all ™Limited extent ™Moderate extent ™Considerable extent ™Great extent |
1 | Terminology: pilot --> airman. |
|
| Terminology | What are your reasons for responding [‘Not at all’, ‘Limited extent’, or ‘Moderate extent’] to the question asking to what extent the FAA pilot medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Exam is not comprehensive enough to adequately screen pilots |
Mark all that apply | Display question if ‘Not at all,’ ‘Limited extent,’ or ‘Moderate extent’ on item 40 | What are your reasons for responding [‘Not at all’, ‘Limited extent’, or ‘Moderate extent’] to the question asking to what extent the FAA airman medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Exam is not comprehensive enough to adequately screen pilots |
Mark all that apply | Display question if ‘Not at all,’ ‘Limited extent,’ or ‘Moderate extent’ on item 40 | 1 | Terminology: pilot --> airman. Question prompt contains piped text. |
| Terminology | What are your reasons for responding [‘Not at all’, ‘Limited extent’, or ‘Moderate extent’] to the question asking to what extent the FAA pilot medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Not all AMEs perform thorough exams |
Mark all that apply | Display question if ‘Not at all,’ ‘Limited extent,’ or ‘Moderate extent’ on item 40 | What are your reasons for responding [‘Not at all’, ‘Limited extent’, or ‘Moderate extent’] to the question asking to what extent the FAA airman medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Not all AMEs perform thorough exams |
Mark all that apply | Display question if ‘Not at all,’ ‘Limited extent,’ or ‘Moderate extent’ on item 40 | 1 | Terminology: pilot --> airman. Question prompt contains piped text. |
| Terminology | What are your reasons for responding [‘Not at all’, ‘Limited extent’, or ‘Moderate extent’] to the question asking to what extent the FAA pilot medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Deters pilots from applying for medical certification |
Mark all that apply | Display question if ‘Not at all,’ ‘Limited extent,’ or ‘Moderate extent’ on item 40 | What are your reasons for responding [‘Not at all’, ‘Limited extent’, or ‘Moderate extent’] to the question asking to what extent the FAA airman medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Deters pilots from applying for medical certification |
Mark all that apply | Display question if ‘Not at all,’ ‘Limited extent,’ or ‘Moderate extent’ on item 40 | 1 | Terminology: pilot --> airman. Question prompt contains piped text. |
| Terminology | What are your reasons for responding [‘Not at all’, ‘Limited extent’, or ‘Moderate extent’] to the question asking to what extent the FAA pilot medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Encourages pilots to be dishonest on application for medical certification |
Mark all that apply | Display question if ‘Not at all,’ ‘Limited extent,’ or ‘Moderate extent’ on item 40 | What are your reasons for responding [‘Not at all’, ‘Limited extent’, or ‘Moderate extent’] to the question asking to what extent the FAA airman medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Encourages pilots to be dishonest on application for medical certification |
Mark all that apply | Display question if ‘Not at all,’ ‘Limited extent,’ or ‘Moderate extent’ on item 40 | 1 | Terminology: pilot --> airman. Question prompt contains piped text. |
| Terminology | What are your reasons for responding [‘Not at all’, ‘Limited extent’, or ‘Moderate extent’] to the question asking to what extent the FAA pilot medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Other reason (explain below) |
Mark all that apply | Display question if ‘Not at all,’ ‘Limited extent,’ or ‘Moderate extent’ on item 40 | What are your reasons for responding [‘Not at all’, ‘Limited extent’, or ‘Moderate extent’] to the question asking to what extent the FAA airman medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Other reason (explain below) |
Mark all that apply | Display question if ‘Not at all,’ ‘Limited extent,’ or ‘Moderate extent’ on item 40 | 1 | Terminology: pilot --> airman. Question prompt contains piped text. |
| SAME | Other reason for your response: | Open text | Display question if 'Other reason(s) (explain below)' was selected for item 41 | Other reason for your response: | Open text | Display question if 'Other reason(s) (explain below)' was selected for item 41 | 0 | |
| Terminology | What are your reasons for responding [‘Considerable extent’ or ‘Great extent’] to the question asking to what extent the FAA pilot medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Ensures pilots are medically safe to fly |
Mark all that apply | Display question if ‘Considerable extent’ or ‘Great extent’ on item 40 | What are your reasons for responding [‘Considerable extent’ or ‘Great extent’] to the question asking to what extent the FAA airman medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Ensures pilots are medically safe to fly |
Mark all that apply | Display question if ‘Considerable extent’ or ‘Great extent’ on item 40 | 1 | Terminology: pilot --> airman. Question prompt contains piped text. |
| Terminology | What are your reasons for responding [‘Considerable extent’ or ‘Great extent’] to the question asking to what extent the FAA pilot medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Deters pilots from flying, if not medically qualified |
Mark all that apply | Display question if ‘Considerable extent’ or ‘Great extent’ on item 40 | What are your reasons for responding [‘Considerable extent’ or ‘Great extent’] to the question asking to what extent the FAA airman medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Deters pilots from flying, if not medically qualified |
Mark all that apply | Display question if ‘Considerable extent’ or ‘Great extent’ on item 40 | 1 | Terminology: pilot --> airman. Question prompt contains piped text. |
| Terminology | What are your reasons for responding [‘Considerable extent’ or ‘Great extent’] to the question asking to what extent the FAA pilot medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Other reason (explain below) |
Mark all that apply | Display question if ‘Considerable extent’ or ‘Great extent’ on item 40 | What are your reasons for responding [‘Considerable extent’ or ‘Great extent’] to the question asking to what extent the FAA airman medical certification process ensures the safety of the National Airspace System? [mark all that apply] - Other reason (explain below) |
Mark all that apply | Display question if ‘Considerable extent’ or ‘Great extent’ on item 40 | 1 | Terminology: pilot --> airman. Question prompt contains piped text. |
| SAME | Other reason for your response: | Open text | Display question if 'Other reason (explain below)' is selected on item 42 | Other reason for your response: | Open text | Display question if 'Other reason (explain below)' is selected on item 42 | 0 | |
| SAME | Was your medical certificate issued on the same day as your exam appointment? (response required) | ™Yes (skip to item 55, on page 11) ™No |
If 'Yes' is selected, skip to item 55 | Was your medical certificate issued on the same day as your exam appointment? (response required) | ™Yes ™No |
1 | ||
| SAME | Which of the following best describes the processing of your application for a medical certification? (response required) | ™The AME required additional information before issuing my certificate ™The AME deferred my application for review to the Regional Flight Surgeon (RFS) or to the Aerospace Medical Certification Division (AMCD) in Oklahoma City (skip to item 47, on the next page) |
Display question if ‘No’ on item 43 | Which of the following best describes the processing of your application for a medical certification? (response required) | ™The AME required additional information before issuing my certificate ™The AME deferred my application for review to the Regional Flight Surgeon (RFS) or to the Aerospace Medical Certification Division (AMCD) in Oklahoma City (skip to item 47, on the next page) |
Display question if ‘No’ on item 43 | 1 | |
| SAME | Did your AME explain to you the requirements for additional documentation to meet FAA standards? | ™Yes ™No ™Do not remember (Valid - not recoded out) |
Display question if ‘AME required additional information’ on item 44 | Did your AME explain to you the requirements for additional documentation to meet FAA standards? | ™Yes ™No ™Do not remember |
Display question if ‘AME required additional information’ on item 44 | 1 | Response option 'Do not remember' is valid - not recoded out. |
| SAME | How long from the date of the exam did the AME tell you it would take to receive a decision regarding your medical certification? | ™Did not say ™0-1 day ™2-10 days ™11-30 days ™31-90 days ™91 days or more ™Do not remember |
Display question if ‘AME required additional information’ on item 44 | How long from the date of the exam did the AME tell you it would take to receive a decision regarding your medical certification? | ™Did not say ™0-1 day ™2-10 days ™11-30 days ™31-90 days ™91 days or more ™Do not remember |
Display question if ‘AME required additional information’ on item 44 | 1 | |
| SAME | Which of the following best describes what happened after the AME deferred your application to the RFS or the AMCD in Oklahoma City? (response required) | ™No additional information was requested from me before being issued my certificate ™I had to supply additional information, and then was issued my certificate ™I have been contacted by the FAA and my application is still under review (skip to item 49) ™I was denied a medical certificate (skip to item 49) ™I have not been contacted by the FAA (skip to item 55, on page 11) |
Display question if ‘AME deferred my application’ on item 44 | Which of the following best describes what happened after the AME deferred your application to the RFS or the AMCD in Oklahoma City? (response required) | ™No additional information was requested from me before being issued my certificate ™I had to supply additional information, and then was issued my certificate ™I have been contacted by the FAA and my application is still under review (skip to item 49) ™I was denied a medical certificate (skip to item 49) ™I have not been contacted by the FAA (skip to item 55, on page 11) |
Display question if ‘AME deferred my application’ on item 44 | 1 | |
| SAME | How long did it actually take to receive a decision on your medical certification? | ™0-1 day 2-10 days ™11-30 days ™31-90 days ™91 days or more ™Do not remember |
Display question if ‘No additional information was requested’ or 'I had to supply additional information' on item 47 | How long did it actually take to receive a decision on your medical certification? | ™0-1 day 2-10 days ™11-30 days ™31-90 days ™91 days or more ™Do not remember |
Display question if ‘No additional information was requested’ or 'I had to supply additional information' on item 47 | 1 | |
| SAME | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Regional Medical Division/Regional Flight Surgeon (RFS) Office - No contact |
Mark all that apply | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Regional Medical Division/Regional Flight Surgeon (RFS) Office - No contact |
Mark all that apply | 1 | |||
| SAME | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Regional Medical Division/Regional Flight Surgeon (RFS) Office - Phone |
Mark all that apply | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Regional Medical Division/Regional Flight Surgeon (RFS) Office - Phone |
Mark all that apply | 1 | |||
| SAME | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Regional Medical Division/Regional Flight Surgeon (RFS) Office |
Mark all that apply | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Regional Medical Division/Regional Flight Surgeon (RFS) Office |
Mark all that apply | 1 | |||
| SAME | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Regional Medical Division/Regional Flight Surgeon (RFS) Office - Postal mail |
Mark all that apply | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Regional Medical Division/Regional Flight Surgeon (RFS) Office - Postal mail |
Mark all that apply | 1 | |||
| SAME | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Aerospace Medical Certification Division (AMCD) – Oklahoma City - No contact |
Mark all that apply | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Aerospace Medical Certification Division (AMCD) – Oklahoma City - No contact |
Mark all that apply | 1 | |||
| SAME | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Aerospace Medical Certification Division (AMCD) – Oklahoma City - Phone |
Mark all that apply | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Aerospace Medical Certification Division (AMCD) – Oklahoma City - Phone |
Mark all that apply | 1 | |||
| SAME | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Aerospace Medical Certification Division (AMCD) – Oklahoma City |
Mark all that apply | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Aerospace Medical Certification Division (AMCD) – Oklahoma City |
Mark all that apply | 1 | |||
| SAME | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Aerospace Medical Certification Division (AMCD) – Oklahoma City - Postal mail |
Mark all that apply | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Aerospace Medical Certification Division (AMCD) – Oklahoma City - Postal mail |
Mark all that apply | 1 | |||
| SAME | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Office of Aerospace Medicine – Washington, DC - No contact |
Mark all that apply | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Office of Aerospace Medicine – Washington, DC - No contact |
Mark all that apply | 1 | |||
| SAME | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Office of Aerospace Medicine – Washington, DC - Phone |
Mark all that apply | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Office of Aerospace Medicine – Washington, DC - Phone |
Mark all that apply | 1 | |||
| SAME | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Office of Aerospace Medicine – Washington, DC |
Mark all that apply | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Office of Aerospace Medicine – Washington, DC |
Mark all that apply | 1 | |||
| SAME | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Office of Aerospace Medicine – Washington, DC- Postal mail |
Mark all that apply | Did you have contact with a medical representative concerning issuance of your medical certificate at any of the following FAA offices? [mark all that apply] - Office of Aerospace Medicine – Washington, DC- Postal mail |
Mark all that apply | 1 | |||
| SAME | What was the longest time that the FAA medical representative(s) told you it would take to receive a decision on your medical certificate? |
™Did not say 0-1 day ™2-10 days ™11-30 days ™31-90 days ™91 days or more ™Do not remember (Valid - not recoded out) |
Display question if ‘contacted' phone, E-mail, or postal mail’ on item 49 | What was the longest time that the FAA medical representative(s) told you it would take to receive a decision on your medical certificate? |
™Did not say 0-1 day ™2-10 days ™11-30 days ™31-90 days ™91 days or more ™Do not remember |
Display question if 'phone',' E-mail', or 'postal mail’ on item 49 | 1 | |
| SAME | To what extent did the FAA medical representative(s) you had contact with… - clearly explain your responsibilities in the medical certification process? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if ‘contacted' phone, E-mail, or postal mail’ on item 49 | To what extent did the FAA medical representative(s) you had contact with… - clearly explain your responsibilities in the medical certification process? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'phone',' E-mail', or 'postal mail’ on item 49 | 1 | |
| SAME | To what extent did the FAA medical representative(s) you had contact with… - provide you with all the information you requested? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if ‘contacted' phone, E-mail, or postal mail’ on item 49 | To what extent did the FAA medical representative(s) you had contact with… - provide you with all the information you requested? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'phone',' E-mail', or 'postal mail’ on item 49 | 1 | |
| SAME | To what extent did the FAA medical representative(s) you had contact with… - provide information you requested in a timely manner? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if ‘contacted' phone, E-mail, or postal mail’ on item 49 | To what extent did the FAA medical representative(s) you had contact with… - provide information you requested in a timely manner? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'phone',' E-mail', or 'postal mail’ on item 49 | 1 | |
| SAME | To what extent did the FAA medical representative(s) you had contact with… - provide you with accurate information? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if ‘contacted' phone, E-mail, or postal mail’ on item 49 | To what extent did the FAA medical representative(s) you had contact with… - provide you with accurate information? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'phone',' E-mail', or 'postal mail’ on item 49 | 1 | |
| SAME | To what extent did the FAA medical representative(s) you had contact with… - treat you with courtesy and respect? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if ‘contacted' phone, E-mail, or postal mail’ on item 49 | To what extent did the FAA medical representative(s) you had contact with… - treat you with courtesy and respect? |
Not at all Limited extent Moderate extent Considerable extent Great extent N/A |
Display question if 'phone',' E-mail', or 'postal mail’ on item 49 | 1 | |
| SAME | Overall how satisfied were you with the quality of services provided by the FAA medical representative(s)? (response required) | ™Very dissatisfied ™Dissatisfied ™Neither dissatisfied nor satisfied ™Satisfied ™Very satisfied |
If 'neither dissatisfied nor satisfied,' 'Satisfied,' or 'Very satisfied' are selected, skip to 54 | Overall how satisfied were you with the quality of services provided by the FAA medical representative(s)? (response required) | ™Very dissatisfied ™Dissatisfied ™Neither dissatisfied nor satisfied ™Satisfied ™Very satisfied |
Display question if 'phone',' E-mail', or 'postal mail’ on item 49 | 1 | |
| SAME | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Denied my medical certificate |
Mark all that apply | Display question if ‘'Very dissatisfied or 'Dissatisfied on item 52 | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Denied my medical certificate |
Mark all that apply | Display question if ‘Very dissatisfied' or 'Dissatisfied on item 52 | 1 | Fixed display log typo in 2023 for 2025. |
| SAME | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Not treated with courtesy and respect |
Mark all that apply | Display question if ‘'Very dissatisfied or 'Dissatisfied on item 52 | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Not treated with courtesy and respect |
Mark all that apply | Display question if ‘Very dissatisfied' or 'Dissatisfied on item 52 | 1 | Fixed display log typo in 2023 for 2025. |
| SAME | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Not adequately informed of requirements for additional documentation |
Mark all that apply | Display question if ‘'Very dissatisfied or 'Dissatisfied on item 52 | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Not adequately informed of requirements for additional documentation |
Mark all that apply | Display question if ‘Very dissatisfied' or 'Dissatisfied on item 52 | 1 | Fixed display log typo in 2023 for 2025. |
| SAME | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Failed to explain requirements for additional documentation |
Mark all that apply | Display question if ‘'Very dissatisfied or 'Dissatisfied on item 52 | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Failed to explain requirements for additional documentation |
Mark all that apply | Display question if ‘Very dissatisfied' or 'Dissatisfied on item 52 | 1 | Fixed display log typo in 2023 for 2025. |
| SAME | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Not informed of status of application |
Mark all that apply | Display question if ‘'Very dissatisfied or 'Dissatisfied on item 52 | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Not informed of status of application |
Mark all that apply | Display question if ‘Very dissatisfied' or 'Dissatisfied on item 52 | 1 | Fixed display log typo in 2023 for 2025. |
| SAME | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Poor communication on where application was in the review process |
Mark all that apply | Display question if ‘'Very dissatisfied or 'Dissatisfied on item 52 | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Poor communication on where application was in the review process |
Mark all that apply | Display question if ‘Very dissatisfied' or 'Dissatisfied on item 52 | 1 | Fixed display log typo in 2023 for 2025. |
| SAME | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Took too long to complete the review |
Mark all that apply | Display question if ‘'Very dissatisfied or 'Dissatisfied on item 52 | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Took too long to complete the review |
Mark all that apply | Display question if ‘Very dissatisfied' or 'Dissatisfied on item 52 | 1 | Fixed display log typo in 2023 for 2025. |
| SAME | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Other reason(s) (explain below) |
Mark all that apply | Display question if ‘'Very dissatisfied or 'Dissatisfied on item 52 | Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)? [mark all that apply] - Other reason(s) (explain below) |
Mark all that apply | Display question if ‘Very dissatisfied' or 'Dissatisfied on item 52 | 1 | Fixed display log typo in 2023 for 2025. |
| SAME | Other reason(s) you were dissatisfied with quality of services provided by the FAA medical representative(s): | Open text | Display question if 'Other reason(s) (explain below)' on item 53 | Other reason(s) you were dissatisfied with quality of services provided by the FAA medical representative(s): | Open text | Display question if 'Other reason(s) (explain below)' on item 53 | 0 | |
| Terminology | Based on your most recent experience with the FAA medical representative(s), to what extent does the FAA pilot medical certification process ensure the safety of the National Airspace System? | ™Not at all ™Limited extent ™Moderate extent ™Considerable extent ™Great extent |
Based on your most recent experience with the FAA medical representative(s), to what extent does the FAA airman medical certification process ensure the safety of the National Airspace System? | ™Not at all ™Limited extent ™Moderate extent ™Considerable extent ™Great extent |
Display question if 'phone',' E-mail', or 'postal mail’ on item 49 | 1 | Terminology: pilot --> airman. |
|
| BLANK | Blank | |||||||
| SAME | How can the FAA make the medical certification process easier for you? [mark all that apply] - Provide a list of approved medications |
Mark all that apply | How can the FAA make the medical certification process easier for you? [mark all that apply] - Provide a list of approved medications |
Mark all that apply | 1 | |||
| SAME | How can the FAA make the medical certification process easier for you? [mark all that apply] - Allow me to attach supporting documents in MedXPress |
Mark all that apply | How can the FAA make the medical certification process easier for you? [mark all that apply] - Allow me to attach supporting documents in MedXPress |
Mark all that apply | 1 | |||
| SAME | How can the FAA make the medical certification process easier for you? [mark all that apply] - Improve communication (answer phones, provide email, automated phone callbacks, etc.) |
Mark all that apply | How can the FAA make the medical certification process easier for you? [mark all that apply] - Improve communication (answer phones, provide email, automated phone callbacks, etc.) |
Mark all that apply | 1 | |||
| SAME | How can the FAA make the medical certification process easier for you? [mark all that apply] - Speed up review process/respond in a timely manner |
Mark all that apply | How can the FAA make the medical certification process easier for you? [mark all that apply] - Speed up review process/respond in a timely manner |
Mark all that apply | 1 | |||
| SAME | How can the FAA make the medical certification process easier for you? [mark all that apply] - Retain medical history in application/add entry field to indicate no change since last medical |
Mark all that apply | How can the FAA make the medical certification process easier for you? [mark all that apply] - Retain medical history in application/add entry field to indicate no change since last medical |
Mark all that apply | 1 | |||
| SAME | How can the FAA make the medical certification process easier for you? [mark all that apply] - Allow AME/PCP/Specialist to make medical decisions/Trust AME/PCP reports in lieu of additional tests |
Mark all that apply | How can the FAA make the medical certification process easier for you? [mark all that apply] - Allow AME/PCP/Specialist to make medical decisions/Trust AME/PCP reports in lieu of additional tests |
Mark all that apply | 1 | |||
| SAME | How can the FAA make the medical certification process easier for you? [mark all that apply] - Provide list of requirements/tests needed up front when deferred |
Mark all that apply | How can the FAA make the medical certification process easier for you? [mark all that apply] - Provide list of requirements/tests needed up front when deferred |
Mark all that apply | 1 | |||
| SAME | How can the FAA make the medical certification process easier for you? [mark all that apply] - Other (explain below) |
Mark all that apply | How can the FAA make the medical certification process easier for you? [mark all that apply] - Other (explain below) |
Mark all that apply | 1 | |||
| SAME | Other way(s) the FAA can make the medical certification process easier: | Open text | Display question if 'Other (explain below) is selected | Other way(s) the FAA can make the medical certification process easier: | Open text | Display question if 'Other (explain below) is selected on item 55 | 0 | |
| New Response options | What year was your most recent FAA medical certification examination? | 2017 ™2018 2019 2020 2021 2022 2023 |
What year was your most recent FAA medical certification examination? | 2019 2020 2021 2022 2023 2024 2025 |
1 | Updated year response options (added latest 2 years; removed oldest 2 years) | ||
| Terminology | Which pilot certificate(s) do you currently hold? [mark all that apply] - Student |
Mark all that apply | Which airman certificate(s) do you currently hold? [mark all that apply] - Student |
Mark all that apply | 1 | Terminology: pilot --> airman. |
||
| Terminology | Which pilot certificate(s) do you currently hold? [mark all that apply] - Sport |
Mark all that apply | Which airman certificate(s) do you currently hold? [mark all that apply] - Sport |
Mark all that apply | 1 | Terminology: pilot --> airman. |
||
| Terminology | Which pilot certificate(s) do you currently hold? [mark all that apply] - Recreational |
Mark all that apply | Which airman certificate(s) do you currently hold? [mark all that apply] - Recreational |
Mark all that apply | 1 | Terminology: pilot --> airman. |
||
| Terminology | Which pilot certificate(s) do you currently hold? [mark all that apply] - Private |
Mark all that apply | Which airman certificate(s) do you currently hold? [mark all that apply] - Private |
Mark all that apply | 1 | Terminology: pilot --> airman. |
||
| Terminology | Which pilot certificate(s) do you currently hold? [mark all that apply] - Commercial |
Mark all that apply | Which airman certificate(s) do you currently hold? [mark all that apply] - Commercial |
Mark all that apply | 1 | Terminology: pilot --> airman. |
||
| Terminology | Which pilot certificate(s) do you currently hold? [mark all that apply] - Airline Transport |
Mark all that apply | Which airman certificate(s) do you currently hold? [mark all that apply] - Airline Transport |
Mark all that apply | 1 | Terminology: pilot --> airman. |
||
| SAME | Which rating(s) do you currently hold? [mark all that apply] - Do not hold any rating |
Mark all that apply | Which rating(s) do you currently hold? [mark all that apply] - Do not hold any rating |
Mark all that apply | 1 | |||
| SAME | Which rating(s) do you currently hold? [mark all that apply] - Instrument Flight Rules (IFR) |
Mark all that apply | Which rating(s) do you currently hold? [mark all that apply] - Instrument Flight Rules (IFR) |
Mark all that apply | 1 | |||
| SAME | Which rating(s) do you currently hold? [mark all that apply] - Certified Flight Instructor (CFI) |
Mark all that apply | Which rating(s) do you currently hold? [mark all that apply] - Certified Flight Instructor (CFI) |
Mark all that apply | 1 | |||
| SAME | Which rating(s) do you currently hold? [mark all that apply] - Other rating(s) (explain below) |
Mark all that apply | Which rating(s) do you currently hold? [mark all that apply] - Other rating(s) (explain below) |
Mark all that apply | 1 | |||
| SAME | Other rating(s) you currently hold: | Open text | Display question if 'Other rating(s) (explain below)' on item 58 | Other rating(s) you currently hold: | Open text | Display question if 'Other rating(s) (explain below)' on item 58 | 0 | |
| SAME | Are you currently employed as a pilot? (response required) | ™Not employed as a pilot (skip to item 61, on the next page) ™Part-time pilot ™Full-time pilot |
Are you currently employed as a pilot? (response required) | ™Not employed as a pilot (skip to item 61, on the next page) ™Part-time pilot ™Full-time pilot |
1 | |||
| SAME | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 61 (Sport pilot) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 61 (Sport pilot) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | 1 | |
| SAME | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 91 (Corporate) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 91 (Corporate) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | 1 | |
| SAME | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 121 (Flag, domestic, supplemental operations) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 121 (Flag, domestic, supplemental operations) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | 1 | |
| SAME | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 125 (Aircraft with 20 or more seats and cargo payload of 6,000 pounds or more when common carriage is not involved) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 125 (Aircraft with 20 or more seats and cargo payload of 6,000 pounds or more when common carriage is not involved) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | 1 | |
| SAME | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 129 (Foreign air carrier & foreign operator of US-registered aircraft used in common carriage) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 129 (Foreign air carrier & foreign operator of US-registered aircraft used in common carriage) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | 1 | |
| SAME | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 133 (Rotorcraft external loads) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 133 (Rotorcraft external loads) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | 1 | |
| SAME | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 135 (Commuter/On-demand operations) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 135 (Commuter/On-demand operations) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | 1 | |
| SAME | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 137 (Agricultural operations) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 137 (Agricultural operations) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | 1 | |
| SAME | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 141 (Pilot schools) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 141 (Pilot schools) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | 1 | |
| SAME | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 142 (Training centers) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Part 142 (Training centers) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | 1 | |
| SAME | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Other Part or Operation (explain below) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | Is your employment as a pilot with a certificated operator conducting flights under the following? [mark all that apply] - Other Part or Operation (explain below) |
Mark all that apply | Display question if ‘Part-time pilot' or 'Full-time pilot' on item 59 | 1 | |
| SAME | Other Part or Operation employing you as a pilot: | Open text | Display question if 'Other Part or Operation (explain below)' on item 60 | Other Part or Operation employing you as a pilot: | Open text | Display question if 'Other Part or Operation (explain below)' on item 60 | 0 | |
| SAME | Approximately, how many total flight hours have you flown? | Open text | Approximately, how many total flight hours have you flown? | Open text | 1 | |||
| SAME | Approximately, how many flight hours have you flown in the past 12 months? | Fewer than 10 hours 10-25 hours 26-50 hours 51-100 hours More than 100 hours |
Approximately, how many flight hours have you flown in the past 12 months? | Fewer than 10 hours 10-25 hours 26-50 hours 51-100 hours More than 100 hours |
1 | |||
| Spelling | If more than 100 hours, please estiamte total flight hours you have flown in the past 12 months: | Open text | Display if "more than 100 hours" is selected on q62 | If more than 100 hours, please estimate total flight hours you have flown in the past 12 months: | Open text | Display if 'more than 100 hours' on item 62 | 0 | New item for 2021. Data will be available for trending if requested. |
| SAME | Which of the following best describes your age group: | ™16-24 ™25-34 ™35-44 ™45-54 ™55-64 ™65 or older |
Which of the following best describes your age group: | ™16-24 ™25-34 ™35-44 ™45-54 ™55-64 ™65 or older |
1 | |||
| SAME | Was your last medical certification a Special Issuance Authorization? | Yes No |
Was your last medical certification a Special Issuance Authorization? | Yes No |
1 | |||
| SAME | Are you aware of Medical Reform under the FAA Extension, Safety, and Security Act of 2016, known as BasicMed? (response required) | ™Yes ™No (skip to item 67) |
Are you aware of Medical Reform under the FAA Extension, Safety, and Security Act of 2016, known as BasicMed? (response required) | ™Yes ™No (skip to item 67) |
1 | |||
| SAME | Do you plan to take advantage of BasicMed? | ™ Yes ™ No |
Display question if 'Yes' on item 65 | Do you plan to take advantage of BasicMed? | ™ Yes ™ No |
Display question if 'Yes' on item 65 | 1 | |
| Terminology | Which region handled your most recent application for pilot medical certification? (response required) | Alaskan (Alaska) ™Central (Iowa, Kansas, Missouri, Nebraska) ™Eastern (Delaware, Maryland, New Jersey, New York, Pennsylvania, Virginia, Washington DC, West Virginia) ™Great Lakes (Illinois, Indiana, Michigan, Minnesota, North Dakota, Ohio, South Dakota, Wisconsin) ™New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) ™Northwest Mountain (Colorado, Idaho, Montana, Oregon, Utah, Washington, Wyoming) ™Southern (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee) ™Southwest (Arkansas, Louisiana, New Mexico, Oklahoma, Texas) ™Western-Pacific (Arizona, California, Hawaii, Nevada) Mike Monroney Aeronautical Center (Civil Aerospace Medical Institute; CAMI) Don't know |
Which region handled your most recent application for airman medical certification? (response required) | Alaskan (Alaska) ™Central (Iowa, Kansas, Missouri, Nebraska) ™Eastern (Delaware, Maryland, New Jersey, New York, Pennsylvania, Virginia, Washington DC, West Virginia) ™Great Lakes (Illinois, Indiana, Michigan, Minnesota, North Dakota, Ohio, South Dakota, Wisconsin) ™New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) ™Northwest Mountain (Colorado, Idaho, Montana, Oregon, Utah, Washington, Wyoming) ™Southern (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee) ™Southwest (Arkansas, Louisiana, New Mexico, Oklahoma, Texas) ™Western-Pacific (Arizona, California, Hawaii, Nevada) Mike Monroney Aeronautical Center (Civil Aerospace Medical Institute; CAMI) Don't know |
1 | Terminology: pilot --> airman. |
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| Terminology | Do you have any additional feedback for the FAA, beyond what you have already provided, regarding pilot medical certification services? [mark all that apply] - Compliment |
Mark all that apply | Do you have any additional feedback for the FAA, beyond what you have already provided, regarding airman medical certification services? [mark all that apply] - Compliment |
Mark all that apply | 1 | Terminology: pilot --> airman. |
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| Terminology | Do you have any additional feedback for the FAA, beyond what you have already provided, regarding pilot medical certification services? [mark all that apply] - Complaint |
Mark all that apply | Do you have any additional feedback for the FAA, beyond what you have already provided, regarding airman medical certification services? [mark all that apply] - Complaint |
Mark all that apply | 1 | Terminology: pilot --> airman. |
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| Terminology | Do you have any additional feedback for the FAA, beyond what you have already provided, regarding pilot medical certification services? [mark all that apply] - Recommendation for improvement |
Mark all that apply | Do you have any additional feedback for the FAA, beyond what you have already provided, regarding airman medical certification services? [mark all that apply] - Recommendation for improvement |
Mark all that apply | 1 | Terminology: pilot --> airman. |
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| Terminology | Do you have any additional feedback for the FAA, beyond what you have already provided, regarding pilot medical certification services? [mark all that apply] - General comment |
Mark all that apply | Do you have any additional feedback for the FAA, beyond what you have already provided, regarding airman medical certification services? [mark all that apply] - General comment |
Mark all that apply | 1 | Terminology: pilot --> airman. |
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| Terminology | Do you have any additional feedback for the FAA, beyond what you have already provided, regarding pilot medical certification services? [mark all that apply] - Nothing more to add |
Mark all that apply | Do you have any additional feedback for the FAA, beyond what you have already provided, regarding airman medical certification services? [mark all that apply] - Nothing more to add |
Mark all that apply | 1 | Terminology: pilot --> airman. |
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| SAME | Compliment(s): | Open text | Compliment(s): | Open text | 0 | |||
| SAME | Complaint(s): | Open text | Complaint(s): | Open text | 0 | |||
| SAME | Recommendation for improvement(s): | Open text | Recommendation for improvement(s): | Open text | 0 | |||
| SAME | General comment(s): | Open text | General comment(s): | Open text | 0 |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |