Dr. Campbell's Flight Health Survey
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What is your current marital status?
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What is your age? *
Have you ever been injured on an airplane? (Check all that apply?)
How many years have you been flying as a Flight Attendant? *
Have you ever had any of the following conditions? (If so please indicate if the condition was pre-existent or how many years you had been flying before your symptoms began.) *
Currently Still Experiencing
Never
Pre-Flying
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21-25
25 or More
High Cholesterol
Dry Skin
Dry Eyes
Waking with Dry Mouth
Knees and Back Feel Tight on Exertion
Mid Night Sweats
Milk Back Pain
Milk Knee Pain
Milk Acid Reflux
Nail Fungus
Nasal Infections
Yeast Infections
Insomnia
Constipation
Difficulty Falling Asleep
Body feels warm all the time
Palms and soles of feet feel warmer than the rest of your body
Difficulty staying warm
Aversion to cold - chilled easily
Moderate to severe knee pain
Moderate to severe back pain
Moderate to severe hip pain
Mild depression
Intense Night Sweats
Chronic Sinustits
Intense nail fungus, nasal infection or yeast infection
Headache starting at the nape of neck, traveling up then moving around the top of the ear into the eye
Intense headaches that make your eyes throb
Irritable bowel
Acid reflux
Chronic fatigue
Fibromyalgia
Chronic knee pain
Chronic back pain
High Blood Pressure
What is your Gender? *
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