Aviation Psychiatry Triage
First Name
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Last Name
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Your answer
To your best knowledge, why do you think you might need an exam? *
Your answer
Have you been given a deadline to respond to the FAA or anybody else? *
If YES, please provide the deadline
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Email Address
An email address is not required to use the screening tool but may give you the fastest service, even if email if used to schedule a telephone call. You can use an anonymous email address. I don't mind.
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What is your telephone number?
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