Disability Assistance Request

For the best-possible preparation, please let us know about the type of assistance you will need.
Fields marqued with * are required

Flight information

Flight date:

Contact information


Please provide at least one contact (email or phone): *

Primary phone:
Secondary phone:

Type of assistance needed

Select the assistance type(s) you need: *
Will you need to use the CPAP onboard?? *
Will you need to use the POC onboard?? *
Specify what kind of dog: *
Select the level of mobility impairment that best applies to your situation: *
Will you transport your own wheelchair? *
Is it foldable?? *

Additional information