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This form should be submitted for new patients only. Please use the Mission Repeat form if you have already flown on an Angel Flight SoarsTM mission.

 

Mission Intake Form


To be considered for free air transportation, please answer all questions



All patients and passengers must agree to and understand to the following before being accepted for free air transportation


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Contact Information (if different from patient)



Patient Information




Medical


*** Please Note: wheelchairs must be shipped ***

Origination and Destination


(Select from the drop down box or start typing to search)

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Ground Transportation and Lodging WHILE AT TREATMENT



Passenger #1 Information


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RadDatePicker
Open the calendar popup.

*** Baggage must be in soft sided bag ***


You be be told your baggage allowance when a member of the mission team calls to speak with you.


Primary Physician Information



Physician at Destination