Passenger Information

To qualify for a LifeLine Pilots’ mission a passenger must meet the following criteria:

  • have a medical or humanitarian need distant from home.
  • have a financial need for assistance.
  • be able to fly in a non-pressurized aircraft.
  • be able to board the aircraft with minimal assistance.
  • be able to sit upright in a standard aircraft seat.
  • be willing to sign a liability release form.
  • provide own transportation to and from the airport
  • submit a completed Mission Request Form for consideration.

Please understand that the Mission Request Form is to determine if you fulfill our criteria for a FREE medical or humanitarian flight.  Information you will need to complete this form is as follows:

  • Name, Address, Phone Number, Email Address
  • Appointment Date
  • Birthdate
  • Exact Weight (required for transportation in a small aircraft)
  • Releasing Physician’s Name, Phone # & Fax #
  • Treating Physician’s Name, Phone # & Fax #
  • Destination Facility, Address, Phone #
  • Companion Information to include, Name, Relationship, Date of Birth, Exact Weight & Phone #

A Physician’s Release will need to be completed & returned to us by your physician before a flight can be set up.  We will fax this form to your physician.

Once your application has been submitted, please call the office to verify no additional information is needed.  You can call toll free at 800-822-7972.  If we are not in the office at the time of your call, please leave your name, location, and phone # with area code on our voicemail.  We will return your call as soon as possible.

Please provide all requested information to help us work quickly on your behalf. While not all flights are possible, we will do our best to help!