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1
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2
SELECT FLIGHT TYPE
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3
CONTACT DETAILS
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Invidual
Name
Surname
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Display Title
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4
ITINERARY DETAILS
Patients
0
1
2
3
4
5
Type of casualty
From :
Agia Roumeli
Agios Kosmas
Aigina
Alexandroupoli
Amanzoe
Amorgos
Anafi
Andros
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Thirassia
Tilos
Tinos
Zakynthos
To :
Agia Roumeli
Agios Kosmas
Aigina
Alexandroupoli
Amanzoe
Amorgos
Anafi
Andros
Antikithira
Antiparos
Arachova
Araxos
Athens
Chalki
Chania
Chios
Corfu Ioannis Kapodistrias Intl
Costa Navarino
Donoussa
Elounda
Folegandros
Gavdos
Gregolimano
Heraklion Nikos Kazantzakis
Ios
Iraklia
Kalamata
Kalymnos
Karpathos
Karpathos – Olympos
Kasteli
Kavos
Kea
Kefalonia
Kimolos
Kos
Koufonissia
Kythnos
Leros
Milos
Mykonos
Naxos
Nisyros
Paros
Patmos
Poros
Porto Heli
Preveza
Rhodes
Samos
Santorini
Schinoussa
Serifos
Sifnos
Sikinos
Sitia
Skiathos
Skyros
Spetses
Symi
Syros
Thessaloniki
Thirassia
Tilos
Tinos
Zakynthos
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5
SPECIAL INFORMATION
Is the Patient medically cleared to fly ?
Yes
No
Can the Patient walk ?
Yes
No
Flight Doctor Required ?
No
Yes
Accompanying Personal Doctor ?
No
Yes
Doctors Name
Doctors Telephone
Special Equipment Required (ICU, oxygen, etc) Please Detail
Number of People accompanying Patient
0
1
2
3
4
5
Will you arrange for conveyance to the aircraft (e.g. ambulance) ?
No
Yes
Will you arrange for an ambulance to meet the aircraft ?
No
Yes
6
SPECIAL INFORMATION
Small luggage
0
1
2
3
4
5
6
7
8
9
10
Large luggage
0
1
2
3
4
5
6
7
8
9
10
Pushchair
No
Yes
Extra luggage
No
Yes
7
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