This test is designed to identify modifiable risk factors which may affect medical certification & flight safety. Order Number Name (optional) Email Address * Do you currently smoke? * Yes No Do you usually eat meals which are low in fat? * Yes No Do you exercise or perform other activity vigorously, at least 2 days per week, for at least 20 minutes? * Yes No Do you usually eat at least 2 servings of vegetables and 2 servings of fruit each day? * Yes No Do you perform stretching or other exercises to prevent back problems at least 3 days per week? * Yes No Do you see a physician each year for a comprehensive physical? (not FAA exam) * Yes No Are you within 20 pounds of your ideal weight? * Yes No Calculate Your Ideal Weight Do you get at least 8 hours of sleep each night and strive to go to bed and wake up at approximately the same time each day respectively? * Yes No Is your blood pressure normal (below 140 / 90)? If unknown, answer no. * Yes No What is a normal BP? Can you pass the IMSAFE check list? * Yes No IMSAFE Check List