Request for Consultation
  • - -
  • On-Site Visit ($3000 [$4000 international] for first day, $1000 for each additional day + expenses billed after visit)
  • A base is defined as any place aircraft/ambulance and medical crew are located.
  • Description of Service

    (Check all that apply to your service)
  • RW FW G ME
    Burns
    Cardiac
    IABP
    Trauma
    Pediatric (PICU)
    High Risk OB
    Adult
    Neonatal
  • Size of the Service

  • RW FW G ME
    Total number of transports in most recent fiscal year
    Total number of dedicated aircraft/ambulance(s)
  • RW FW G ME
    FAA Cert #
    Company Name/Owner/Operator
    Address
  • Office Use Only

  • Added to Checklist