Impaired Risk Questionnaires

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Does your applicant have a medical condition or participate in a hazardous hobby? Click on the topic below to complete an impairment questionnaire. We will respond within 72 hours.

I.R.G. Registration Form  PDF Form Complete Form Online
HIPAA Authorization PDF Form NA
Alcohol & Drug Usage PDF Form Complete Form Online
Anxiety

NA

Complete Form Online
Asthma

NA

Complete Form Online
Blood Pressure NA NA
Cancer PDF Form Complete Form Online
Cerebrovascular Accident (stroke) PDF Form Complete Form Online
Cholesterol NA NA
Chronic Lymphocytic Leukemia PDF Form Complete Form Online
Coronary Angioplasty & Bypass PDF Form Complete Form Online
Depression PDF Form Complete Form Online
Diabetes PDF Form Complete Form Online
Driving Violation PDF Form Complete Form Online
Foreign Residence / Travel PDF Form Complete Form Online
Heart Attack (Myocardial Infarction) PDF Form Complete Form Online
Heart Conditions PDF Form Complete Form Online
Hepatitis (Elevated Liver Functions) PDF Form Complete Form Online
Kidney Transplants PDF Form Complete Form Online
Multiple Sclerosis PDF Form Complete Form Online
Other Illness PDF Form Complete Form Online
Paralysis & Spinal Cord Injury PDF Form Complete Form Online
Parkinson's Disease PDF Form Complete Form Online
Pilot NA Complete Form Online
Preferred Risk PDF Form Complete Form Online
Pulmonary Disease PDF Form Complete Form Online
Rheumatoid Arthritis PDF Form Complete Form Online
Sarcoidosis PDF Form Complete Form Online
Sleep Apnea PDF Form Complete Form Online
Systemic Lupus Erythematosus (SLE) PDF Form Complete Form Online
Ulcerative Colitis (Crohn's Disease) PDF Form Complete Form Online