Submit New Application

Please submit your personal details and your basic medical information. We shall then contact your physician to get in-depth details of your medical condition.

Personal Information

  • Title:
  • Gender:
  • Journey Type:

Medical Information

  • Intended Escort:
  • Stretcher Needed Onboard:
  • Wheelchair needed:
  • Ambulance needed:
  • (to be arranged by the passenger)
  • Other ground arrangements needed:
  • Meet & Assist needed:
Specify equipment needed: (respirator, incubator, oxygen, etc)

Physician Information

We shall send this form to your doctor at this email address