Patient Interview Form

 

Patient Interview Form

If the patient is flying on a medical mission, please answer the following questions.

Patient First Name  *Patient Middle Initial  *Patient Last Name  *Patient Age  *Parent/Guardian First Name Parent/Guardian Last Name When was your medical condition diagnosed? How rare is it? How did you find this doctor/treatment? How frequent are your appointments and how long is each appointment? How did you get to your treatment before you found Angel Flight Soars? If you drove, how long a drive was it? Did your prior transportation cause a hardship (kids at home, unreliable transportation, gas money, etc.)? How have we helped you? Tell us about your experience with Angel Flight Soars. Since being introduced to Angel Flight Soars, has your level of anxiety related to accessing medical care been reduced?  *As a result of Angel Flight Soars' services, do you feel more optimistic about finding a potential solution for your medical condition?  *Do you anticipate an increase in your physical comfort while flying with Angel Flight Soars to/from your medical care, as compared to riding in a car, bus, or commercial plane?  *If the parent of a school-aged child, has Angel Flight Soars had a positive impact on your child's school performance (i.e. less absenteeism, etc.), by providing transportation to/from their medical care/treatment?  *Has Angel Flight Soars had a positive impact on your own daily activities or job performance (i.e. less absenteeism, etc.), by providing transportation to/from your medical care?  *Has your family experienced a decreased level of anxiety about accessing medical care for you after being introduced to Angel Flight Soars' services?  *Has your family experienced an increase in their optimism about finding a solution for your medical condition as a result of Angel Flight Soars offering transportation to/from your medical care?  *