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Veteran Details:


Alternate Contact:(Son, Daughter, etc...)(Please do not use the same contact you plan to use for the emergency contact!)
EMERGENCY CONTACT INFORMATION (someone available the day you travel) (Please Note! This must be a different contact than the alternate contact.)
SERVICE HISTORY:





Medical:
Information provided will NOT disqualify you. It permits us to assess the support we need during the trip. Info is for Honor Flight and medical personnel only.






If within past 5 years, It is STRONGLY advised you discuss trip with your private physician!
If motion sickness is not controlled with medications, it is STRONGLY advised you discuss the trip with your private physician!
If YES, you are STRONGLY encouraged to discuss the trip with your private physician concerning the use of portable hand-held nebulizers during the trip.
If YES, you will need your private physician to write a prescription for oxygen to be used during the flight and during the tour. Oxygen will be provided. The prescription should be turned in with the application.

If YES, it is STRONGLY advised you discuss the trip with your private physician. If you have NEVER flown since the open head injury, sinus or ear problems, again we STRONGLY advise you discuss the trip with your private physician.
If YES, please make sure the bag is vented prior to flight. If you do not know if your bag is vented, it is STRONGLY advised that you discuss this issue with your private physician.