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Individual Inquiry Confidential Questionnaire



NATCA Member Confidential Questionnaire



Corporate & Partnership Confidential Questionnaire





Consult a VFS Doctor

Corporate and Partnership Confidential Questionnaire

Thank you for choosing Virtual Flight Surgeons!  This Confidential Questionnaire is provided for our Corporate and Partnership Program clients whose organizations have arranged for email contact with VFS.

Corporate clients are eligible for services as a result of a company-sponsored benefit.  Eligible clients may submit unlimited questionnaires at no cost.  Please note that some organizations have direct access to the VFS physicians by telephone and their arrangement does not include email contact. If your union, company, or organization is not listed in the drop down menu on the questionnaire, then please contact VFS using the telephone number provided to your organization.  Please see our VFS Clients page for more information.

Some Partnership clients are eligible to submit an annual no-cost inquiry as a membership benefit provided by your aviation organization.  Additional inquiries may be submitted through our fee-for-service Individual Confidential Questionnaire.  Please note that some organizations have direct access to the VFS physicians by telephone and their arrangement does not include email contact.   If your union, company, or organization is not listed in the drop down menu on the questionnaire, please contact VFS using the telephone number provided to your organization.  Please see our VFS Clients page for more information.

Once submitted, a physician will respond to your inquiry within 2 business days.


Name


Address 1


Address 2


City


State


Postal/Zip Code


Country


Preferred Phone Contact


Fax


Preferred E-Mail Contact


Confirm E-Mail


Date Of Birth

Class FAA Medical Certification
 First   Second   Third


Date of Last FAA Medical Exam


I am a member of


My organization is


Question