Inquiry - Air Care Alliance

This form is the fastest way to get your request to all the organizations that may be able to help you.

Please provide the following information to submit your inquiry. Do not include any information you wish to remain private.

* indicates that field is required

Request type

Patients & Medical Transport: Choose if you are a patient, family member, social worker, hospital staff member, or other person needing some type of patient or medical transportation.
Other Missions: Choose if you need the services of groups flying disaster and emergency relief missions, environmental support flights, animal transport, educational flights, or other missions of community service using aviation.
Pilots & Volunteers: Choose if you are a pilot or other person interested in volunteering for one or more groups serving your area. This is for pilots, medical personnel, amateur radio operators, emergency service workers, airport business owners, helpers, and other contributors.
General Info: Choose if you seek general information about all groups serving your own state. This is for anyone interested in charitable flying, including members of the media. If you seek information about groups serving another state, indicate that state here.
Other: Choose if you seek information for any other reason.

Non-medical request

What type of transportation best describes your needs:

Animal Transport/Rescue

Disaster & Emergency relief

Environmental support

Patient request

What type of transportation best describes your needs:

Ambulatory patient - able to sit in an airplane seat and not require professional medical care while flying

Non-ambulatory patient - needs to travel on a stretcher or have professional medical care while flying

Blood, tissue, organs, personnel, or other medical missions not involving patient transport

Does the patient require a stretcher onboard?

Yes No

Is inflight medical attention required?

Yes No

Is the patient traveling for cancer treatment?

Yes No

Will the patient be younger than 18 years of age at the time of travel?

Yes No

Requester I am:

Requesting assistance for myself

Requesting assistance for someone else

My role or relationship to the patient is:

Patient's First Name and Initial only for Last Name:

Contact information Your first name* Your last name* - if you are a patient only provide the last name's first initial

Firm/Agency/Group: Address Address

Country*

State*

City Postal code Phone

Fax Email*

Volunteer interest I am interested in:

Patient/Medical Transport

Environmental support

Emergency Service, Disaster Relief and other Community missions

Animal Transportation

Youth Education

PBF Organization Support

I am:

An active pilot

A student pilot

Non-pilot

General interest I am interested in groups with the following primary mission(s) - check one or more:

Patient/Medical Transport

Environmental support

Emergency Service, Disaster Relief and other Community missions

Animal Transportation

Youth Education

PBF Organization Support

I am:

Press or media

Health care agency or service organization

Non-profit organization

Other

Travel information

Departing From:

Country* State* City

Traveling to:

Country* State* City Going One Way Round-Trip Proposed or possible dates Provide a complete description of the patient's or your need*

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Travel information

Area of coverage location:

Country* State* City Proposed departure point Proposed or possible dates Purpose/Objective of the Flight*
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Referral I was referred to The Air Care Alliance by:

If other, please specify: Please add me to your mailing list: Yes No

We will not share your email address without your consent; please refer to our privacy policy for details.

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