"Supporting the Nationwide Community of  Charitable Aviators
Flying to Help Others"


 


Use this  form to ask about air transportation for a patient or for other medical purposes.

This may be used by patients, family members, friends, social workers, or medical personnel to obtain a list of groups which may be able to provide air transportation given by volunteers.

Use the other buttons for other air transportation inquiries.

Note: If you do NOT seek medical transportation, choose the "Other Missions" button which will list groups flying disaster and emergency relief missions, environmental support flights, or other non medical support missions.

Or choose the "Volunteers & General Information"  button if you are interested in volunteering for or supporting groups serving your area.

If you seek general information about all groups serving your area choose the General Info button.

You may also choose the "Entire List" button if you simply wish us to email you the entire Air Care Alliance list of all groups in all areas.   

Complete the following Form for Medical Transportation inquiries:  
Please provide a little information below and briefly describe why a patient needs to travel or the nature of the medical transportation requested. 

The information provided on this page will be used to identify groups that may be able to help you. It will be sent back to you via email along with a list of the groups we suggest that you contact. A copy will be sent to us and to the groups we name for you.  

Do not include confidential medical information or any other private information.  What you provide will be sent publicly to the groups. Include only enough information to state the general nature of your need.

You must provide a valid email address where we can send you your list of groups.   It will also tell groups where they might be able to contact you, and tell us where we can contact you if we have any other questions or can provide additional information. The other information requested is optional.

Form:

My E-mail 
address is:  		 * Required
My role or my relationship
 to patient is:		 Ex: "patient," "parent," "hospital worker," etc

My other information (optional):

Name
Group/Firm
Address
City, ST ZIP
Telephone
FAX

I need the following type of transportation:  * Required - choose one

For Ambulatory patient 
  (Patient needs no medical assistance and can sit in a seat during flight)

For Non-Ambulatory patient 
  (Patient requires medical assistance during flight = air ambulance transport)

For Other medical mission  
  (blood, tissue, or organ transport and other medical missions)

Departing from: city/town  
                                       state     country/region

Going to:              city/town  
                                        state    country/region

 I request a:      One-way flight    or  Round Trip  

Proposed date or possible dates for trip:

We need this trip in order to:
          (mission description:)

I Heard of the Air Care Alliance through... choose one: 

Please put me on your email announcement list:     Yes    No 

When you are finished entering your information click on the FINISH: SEND..  button below and the Air Care Alliance will send you by email a list of groups in your area that may be of interest to you.  A copy of your information will be sent to those groups and to the Air Care Alliance.

To complete your arrangements you must contact one or more groups on the list we will send you. Groups are not likely to contact you unless you email or call them directly or you specifically ask to be contacted by saying so in the mission description box above.

Please also consider visiting our website's general listings pages and all the groups' own web sites to learn more about their work providing all kinds of community and patient service.

FINISH:  

RESET:

IGNORE MY ENTRIES AND RETURN TO GENERAL INQUIRIES PAGE
 


To email the Air Care Alliance or join our announcement list please contact: mail@aircareall.org 
Air Care Alliance Organizational Contacts:    See Board and Contact List
Send questions or comments about this web site to webmaster@aircareall.org
Copyright © 1998 through 2008  Air Care Alliance          Last modified: June 02, 2008