Airman Medical Certification Services
2021 Airman Feedback Survey
A 2021 Airman Feedback Survey is attached. If you have already completed the survey online, thank you for your feedback.
You will be evaluating the quality of airman medical certification services provided by:
Your Aviation Medical Examiner (AME)
Your Regional Flight Surgeon (RFS) Office
The Aerospace Medical Certification Division (AMCD) in Oklahoma City
You will also evaluate your use of MedXPress (OMB control No. 2120-0707).
The FAA’s Civil Aerospace Medical Institute (CAMI) strictly adheres to ethical standards, public law, and federal policies for safeguarding the confidentiality of all participants in this survey. All data provided will be kept private in accordance with the law. This survey is hosted by a contractor, Cherokee Nation 3S. The contractor will deliver a data file to the FAA for analysis. That data file will not contain any personally identifying information. Only analyses and reports of aggregate data will be produced and released.
Participation in the survey is completely voluntary.
For your convenience, you may complete the survey online using your computer or mobile device, or complete and return the attached paper survey. Submit only one survey.
To access the online survey, either scan the QR code using your mobile device or go to the Internet and type the following into the web address bar: tinyurl.com/airman2021
At the survey log in screen, enter this password: A8M7 (use upper-case letters) and click the ‘Next’ button.
In the event the envelope is missing, mail your completed paper survey to:
FAA Airman Survey (AAM-510)
CAMI, Rm 250D
PO Box 25082
Oklahoma City, OK 73125
For assistance, contact survey support at (405) 954-1594 or email 9-AMC-SURVEYSUPPORT@faa.gov.
Paperwork Reduction Act Statement. Note that a federal agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection of information is 2120-0707, which expires November 30, 2022.
This page intentionally left blank.
Your candid
responses in completing the survey are appreciated. Your feedback
will help us improve medical certification services offered to all
airman applicants. Participation is voluntary and anonymous. Your responses will be kept private to the extent provided by law.
Note: Some items require a response in order to skip items not relevant to you.
|
Based on your most recent application for airman medical certification:
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 an airman medical certificate. (Stop here and return your survey. Thank You!)
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 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)
Reason(s) for traveling 101 miles or more for your appointment: ___________________________________________
______________________________________________________________________________________________
How many AMEs did you contact before making your exam appointment?
1
2
3
4
5 or more
Is your AME your primary care doctor?
Yes
No
Based on your most recent application for airman medical certification:
What was the cost of your examination for your airman medical certification (excluding costs for any additional testing, studies, 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 total cost for any/all additional requirements associated with your airman medical certification examination (e.g., additional testing, studies, evaluations or referrals recommended by the AME or required by the FAA)?
None or not applicable
Less than $100
Between $100 and $200
More than $200 but less than $500
Between $500 and $1000
More than $1000
If more than $1000, please estimate total cost for additional requirements:_________________________________
How did you pay for your airman medical certification examination only (excluding any additional testing, studies, evaluations or referrals recommended by the AME or required by the FAA)?
Out of pocket
Covered by health insurance
Combination of both out of pocket and health insurance
Other (explain below)
Other: ___________________________________________________________________________
How did you pay for any additional testing, studies, evaluations or referrals recommended by the AME or required by the FAA (excluding the exam)?
Not Applicable – no extra testing, studies, evaluations or referrals recommended
Out of pocket
Covered by health insurance
Combination of both out of pocket and health insurance
Other (explain below)
Other: ___________________________________________________________________________
What was the basis for selecting your AME? [mark all that apply]
Referred by flight instructor or school
Referred by airline or AME employed by airline
Referred by pilot
Referred by doctor or previous AME
Performed my previous medical certification exam(s)
Is my primary care doctor
Makes quick certification decisions
Licensed to perform needed service (Class I exam, special issuance, etc.)
Handles complex cases
Nearest location
Earliest available appointment
Low cost
Other reason(s) (explain below)
Other reason(s) for selecting your AME: _____________________________________________________________
_____________________________________________________________________________________________
Based on your most recent application for airman medical certification:
Did the AME’s office tell you to bring the following to your exam appointment?
|
Yes |
No, but did need for exam |
No, not needed for exam |
Do not remember |
Not applicable |
Valid photo ID |
|
|
|
|
|
MedXPress confirmation number |
|
|
|
|
|
Printout of completed Summary Sheet from MedXPress |
|
|
|
|
|
List of your medications |
|
|
|
|
|
Medical history details (e.g., dates of hospitalizations and medical exams) |
|
|
|
|
|
Current medical tests/lab results |
|
|
|
|
|
Past medical tests/lab results |
|
|
|
|
|
Records from medical or mental health evaluations, hospitalizations, etc. |
|
|
|
|
|
Special Issuance Authorization paperwork |
|
|
|
|
|
SODA (statement of demonstrated ability) paperwork |
|
|
|
|
|
Conditions AMEs Can Issue (CACI) paperwork…………… |
|
|
|
|
|
Did you use MedXPress to submit your application? (response required)
Yes
No (answer item 13, then skip to item 22, on page 5)
Do not remember (answer item 13, then skip to item 22, on page 5)
Note: Answer item 13 only if you answered ‘No’ or ‘Do not remember’ on item 12.
Did you use a computer to answer FAA medical application questions?
Yes
No
Do not remember
Note: Answer items 14 and 15 only if you answered ‘Yes’ on item 12.
Did your AME’s office ask you to provide your MedXPress Summary Sheet before your exam appointment? (response required)
Yes
No (skip to item 16, on the next page)
Do not remember (skip to item 16, on the next page)
Note: Answer item 15 only if you answered ‘Yes’ on item 14.
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
Based on your most recent application for airman medical certification:
Note: Answer items 16 through 20 only if you answered ‘Yes’ on item 12.
Overall how satisfied were you with the performance of MedXPress?
Dissatisfied (explain below)
Neither dissatisfied nor satisfied
Satisfied
Very satisfied
Please explain why you were dissatisfied with the performance of MedXPress: _______________________________
______________________________________________________________________________________________
How did MedXPress perform compared to your expectations?
Far below expectations (explain below)
Below expectations (explain below)
Met expectations
Above expectations
Far above expectations
Please explain why MedXPress performed below your expectations: _______________________________________
______________________________________________________________________________________________
Overall how would you rate the performance of MedXPress?
Very poor
Poor
Average
Good
Excellent
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
Did the AME access your MedXPress form online during the exam appointment? (response required)
Yes (skip to item 22, on the next page)
No
Do not know (skip to item 22, on the next page)
Do not remember (skip to item 22, on the next page)
Note: Answer item 21 only if you answered ‘No’ on item 20.
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
My confirmation number had expired
The AME did not require MedXPress
Other reason (explain below)
Other reason the AME did not access your MedXPress form online during the exam appointment: ______________
____________________________________________________________________________________________
Based on your most recent application for airman medical certification:
During your exam appointment, who did each of the following: (response required) [mark all that apply]
|
No one |
AME |
Another physician (not the AME) |
Physician’s Assistant |
Nurse |
Other office personnel |
Do not remember |
Reviewed your medical history with you |
|
|
|
|
|
|
|
Performed your physical exam |
|
|
|
|
|
|
|
Note: Answer item 23 only if you answered ‘AME’ on item 22.
To what extent did your AME do each of the following during your exam appointment?
|
Not at all |
Limited extent |
Moderate extent |
Considerable extent |
Great extent |
N/A |
Obtain a comprehensive history |
|
|
|
|
|
|
Discuss safety risk(s) of current medical condition(s) |
|
|
|
|
|
|
Explain the certification process and airman appeal rights |
|
|
|
|
|
|
Discuss safety risk of over-the-counter (OTC) medications and supplements |
|
|
|
|
|
|
Discuss mental health |
|
|
|
|
|
|
Discuss sleep patterns |
|
|
|
|
|
|
Note: Answer item 24 only if you answered ‘AME’ performed your physical exam on item 22.
|
Yes |
No |
perform a thorough medical exam?……… |
|
|
examine your eyes and ears with a medical device? |
|
|
have you remove or undo articles of clothing for the exam? |
|
|
listen to your heart and lungs? |
|
|
Note: Answer item 25 only if you answered ‘AME’ on item 22.
|
Not at all |
Limited extent |
Moderate extent |
Considerable extent |
Great extent |
N/A |
provide a professional setting for the medical exam, including cleanliness and appearance? |
|
|
|
|
|
|
charge appropriately for services? |
|
|
|
|
|
|
clearly explain your responsibilities in the medical certification process? |
|
|
|
|
|
|
provide you with all the information you requested? |
|
|
|
|
|
|
provide information you requested in a timely manner? |
|
|
|
|
|
|
provide you with accurate information? |
|
|
|
|
|
|
treat you with courtesy and respect? |
|
|
|
|
|
|
Based on your most recent application for airman medical certification:
Note: Answer item 26 only if you answered ‘Not at all’ or ‘Limited extent’ for extent AME provided a professional setting for your exam on item 25.
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)
Unclean or unkempt setting
No privacy
Other reason(s) (explain below)
Other reason(s) for your response: ________________________________________________________________
____________________________________________________________________________________________
During your most recent medical certification exam, did your AME identify or alert 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 (skip to item 29)
Note: Answer item 28 only if you answered ‘Yes’ on item 27.
Did the new health condition(s) require treatment for medical certification?
Yes
No
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 (skip to item 31)
Note: Answer item 30 only if you answered ‘Yes’ on item 29.
Did you receive treatment for the previously existing health condition(s)?
Yes
No
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 33)
Note: Answer item 32 only if you answered ‘Yes’ on item 31.
Did the new health condition(s) require treatment for medical certification?
Yes
No
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 35, on the next page)
Based on your most recent application for airman medical certification:
Note: Answer item 34 only if you answered ‘Yes’ on item 33.
Did you receive treatment for the previously existing health condition(s)?
Yes
No
Overall how satisfied were you with your exam appointment? (response required)
Very dissatisfied
Dissatisfied
Neither dissatisfied nor satisfied (skip to item 37)
Satisfied (skip to item 37)
Very satisfied (skip to item 37)
Note: Answer item 36 only if you answered ‘Very dissatisfied’ or ‘Dissatisfied’ on item 35.
Why were you dissatisfied with your exam appointment? [mark all that apply]
AME did not issue my certificate during the exam appointment
The exam was not thorough
Not examined in a professional environment
AME conducted the exam at a different location than listed in the FAA directory
I had to remove articles of clothing
Not treated with courtesy and respect
Cost of the basic certification examination only
Cost of additional items required by the AME and/or the FAA
Other reason(s) (explain below)
Other reason(s) you were dissatisfied with your exam appointment: ______________________________________
____________________________________________________________________________________________
Overall how satisfied were you with the quality of service provided by your AME? (response required)
Very dissatisfied
Dissatisfied
Neither dissatisfied nor satisfied (skip to item 39, on next page)
Satisfied (skip to item 39, on next page)
Very satisfied (skip to item 39, on next page)
Note: Answer item 38 only if you answered ‘Very dissatisfied’ or ‘Dissatisfied’ on item 37.
Why were you dissatisfied with the quality of AME services? [mark all that apply]
AME did not issue my certificate during the exam appointment
AME lacked knowledge of current airman medical certification standards
Not informed of required documentation to bring to the exam
Not informed of additional documentation that the FAA would require to issue my certificate
Not informed of status of my application
Refused to offer any assistance beyond performing the exam
Other reason(s) (explain below)
Other reason(s) you were dissatisfied with the quality of AME services: __________________________________
___________________________________________________________________________________________
Based on your most recent application for airman medical certification:
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 (skip to item 41)
Great extent (skip to item 41)
Note: Answer item 40 only if you answered ‘Not at all,’ ‘Limited extent,’ or ‘Moderate extent’ on item 39.
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
Not all AMEs perform thorough exams
Deters pilots from applying for medical certification
Encourages pilots to be dishonest on application for medical certification
Other reason (explain below)
Other reason for your response: ________________________________________________________________
__________________________________________________________________________________________
Note: Answer item 41 only if you answered ‘Considerable extent’ or ‘Great extent’ on item 39.
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
Deters pilots from flying, if not medically qualified
Other reason (explain below)
Other reason for your response: ________________________________________________________________
__________________________________________________________________________________________
Was your medical certificate issued on the same day as your exam appointment? (response required)
Yes (skip to item 54, on page 11)
No
Note: Answer item 43 only if you answered ‘No’ on item 42.
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 46, on the next page)
Note: Answer items 44 and 45 only if you answered ‘AME required additional information’ on item 43.
Did your AME explain to you the requirements for additional documentation to meet FAA standards?
Yes
No
Do not remember
Based on your most recent application for airman medical certification:
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
Note: Answer item 46 only if you answered ‘AME deferred my application’ on item 43.
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 48)
I was denied a medical certificate (skip to item 48 )
I have not been contacted by the FAA (skip to item 54, on page 11)
Note: Answer item 47 only if you answered ‘No additional information was requested’ or ‘I had to supply additional information’ on item 46.
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
Items in this section ask about your experiences with FAA medical representatives during your most recent application for airman medical certification. |
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]
|
No contact |
Phone |
Postal mail |
|
Regional Medical Division/Regional Flight Surgeon (RFS) Office |
|
|
|
|
Aerospace Medical Certification Division (AMCD) – Oklahoma City |
|
|
|
|
Office of Aerospace Medicine – Washington, DC |
|
|
|
|
Based on your most recent application for airman medical certification:
Note: Answer items 49 through 53 only if you were contacted (phone, E-mail, or postal mail) by a medical representative concerning issuance of your medical certificate.
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
To what extent did the FAA medical representative(s) you had contact with…
|
Not at all |
Limited extent |
Moderate extent |
Considerable extent |
Great extent |
N/A |
clearly explain your responsibilities in the medical certification process? |
|
|
|
|
|
|
provide you with all the information you requested? |
|
|
|
|
|
|
provide information you requested in a timely manner? |
|
|
|
|
|
|
provide you with accurate information? |
|
|
|
|
|
|
treat you with courtesy and respect? |
|
|
|
|
|
|
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 (skip to item 53, on the next page)
Satisfied (skip to item 53, on the next page)
Very satisfied (skip to item 53, on the next page)
Note: Answer item 52 only if you answered ‘Very dissatisfied’ or ‘Dissatisfied’ on item 51.
Why were you dissatisfied with the quality of services provided by the FAA medical representative(s)?
[mark all that apply]
Denied my medical certificate
Not treated with courtesy and respect
Not adequately informed of requirements for additional documentation
Failed to explain requirements for additional documentation
Not informed of status of application
Poor communication on where application was in the review process
Took too long to complete the review
Other reason(s) (explain below)
Other reason(s) you were dissatisfied with quality of services provided by the FAA medical representative(s):________
______________________________________________________________________________________________
Based on your most recent application for airman medical certification:
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
How can the FAA make the medical certification process easier for you? [mark all that apply]
Allow me to electronically check the status of my medical certificate
Provide a list of approved medications
Allow me to attach supporting documents in MedXPress
Other (explain below)
Other way(s) the FAA can make the medical certification process easier:____________________________________
Items in this section ask about your current airman medical certification, pilot certificate(s), ratings, and employment. |
What year was your most recent FAA medical certification examination?
|
|
|
|
|
|
Which pilot certificate(s) do you currently hold? [mark all that apply]
|
|
|
|
|
|
Which rating(s) do you currently hold? [mark all that apply]
Do not hold any rating
Instrument Flight Rules (IFR)
Certified Flight Instructor (CFI)
Other rating(s) (explain below)
Other rating(s) you currently hold: __________________________________________________________________
_____________________________________________________________________________________________
Are you currently employed as a pilot? (response required)
Not employed as a pilot (skip to item 60, on the next page)
Part-time pilot
Full-time pilot
Note: Answer item 59 only if you answered ‘Part-time pilot’ or ‘Full-time pilot’ on item 58.
Is your employment as a pilot with a certificated operator conducting flights under the following?
[mark all that apply]
Part 61 (Sport pilot)
Part 91 (Corporate)
Part 121 (Flag, domestic, supplemental operations)
Part 125 (Aircraft with 20 or more seats and cargo payload of 6,000 pounds or more when common carriage is not involved)
Part 129 (Foreign air carrier & foreign operator of US-registered aircraft used in common carriage)
Part 133 (Rotorcraft external loads)
Part 135 (Commuter/On-demand operations)
Part 137 (Agricultural operations)
Part 141 (Pilot schools)
Part 142 (Training centers)
Other Part or Operation (explain below)
Other Part or Operation employing you as a pilot: _____________________________________________________
_____________________________________________________________________________________________
Approximately, how many total flight hours have you flown?
|
hours |
[enter a whole number] |
|
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
Which of the following best describes your age group:
16-24
25-34
35-44
45-54
55-64
65 or older
Was your last medical certification a Special Issuance Authorization?
Yes
No
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 66)
Note: Answer item 65 only if you answered ‘Yes’ on item 64.
Do you plan to take advantage of BasicMed?
Yes
No
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
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
Compliment
Complaint
General comment
Nothing more to add
Use the following boxes to provide additional feedback as marked above. [Note: This survey is hosted by a contractor, Cherokee Nation 3S. The contractor will deliver a data file to the FAA for analysis. That data file will not contain any personally identifying information. However, if the nature of your comment is specific to you, your confidentiality cannot be assured. Comments are subject to the Freedom of Information Act.]
Recommendation for improvement(s):
|
|
|
|
Compliment(s):
|
|
|
|
Complaint(s):
|
|
|
|
General comment(s):
|
|
|
|
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | 2014 AMCS Airman Survey - NEW |
Author | Qualtrics |
File Modified | 0000-00-00 |
File Created | 2023-08-26 |