Health certificate

Fill in your health certificate with care. Make sure you answer all the questions.

12LAPL3 (ATC)Cabin CrewOther
MaleFemale
InitialRevalidation/Renewal
DateDoctor and Place
ATPLCPLCPL-IRPPL-IRPPLATCCabin CrewSegelflygULOther
NoYesDetails
NoYesDateCountryDetails
HelicopterMEPMPASEPN/A
NoYesDatePlaceDetails
Single pilotMultipilot
NoYes, weekly amount
NoYes
State medication, dose, date stated and why

No, never
No, date stopped
Yes, state type and amount
General and medical history: Do you have, or have you ever had, any of the following? YES or NO (or has indicated) must be ticked after each question. Elaborate YES answers in remarks section (30).
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
 
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
 
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
 
Family history of
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Females only
YesNoNA
YesNoNA
 
YesNo
 
 

After you clicked the Send button you will recieve a confirmation message next to the button within a few seconds. If you don´t get at message you proboly havent answered all the questions so please scroll up and check for validation errors.