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QUESTIONNAIRE
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When did you fly last?
Never
Less than 1 Year
1-10 Years
Over 10 Years
Are you planning on flying within the next few months?
Yes
No
What do you Fear?
Turbulence
Lack of Control
Fear of the Unknown
Other
Did you always have this Fear, or did it just suddenly develop?
Yes
Just developed
Are you Ready to eliminate your Fear of Flying?
Yes
Not Just Yet
Do you typically fly for business, personal reasons, or some other reason?
Business
Personal reasons
Other reason (please specify)
About how many times do you typically fly each year?
Have you ever cancelled a Flight due to your Fear?
Yes
No
If so, When
Is your Fear the result of a bad experience on an aircraft in the past?
Yes
No
If yes, please specify
Have you taken any action in the past to Eliminate your Fear, Through another Fear of Flying program, or Therapist?
Yes
No
Would you be interested in having a pilot from FlyHome, LLC fly with you on a local flight, and have an "In-Flight" Consultation
Yes
No
Please let us know about any other concerns that you might have?
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