Goose Flights Standard Recipient Application Process

Thank you for visiting our Goose Flights application page for non-emergency medical transportation services. Goose Flights chooses recipients based on a variety of factors and will request the following information once the application has been submitted:

Are you submitting this request for yourself or someone else?

[group application-myself]

I am applying for myself

Your Information

Date of Birth

Please provide detailed and specific information about your health condition.

What city and state do you currently reside in?

Where are you looking to travel for healthcare?

Are you looking for air or ground transportation?

What is your requested date for travel?

Do you need to travel with any medical equipment? YesNo

Will you need a paramedic or nurse present? YesNo

Who will be traveling with you?

Does insurance cover any of the costs for transportation? YesNo

[/group] [group application-someone-else]

I am applying for someone else

Your Information

What is your relationship to the prospective recipient?

Recipients Information

Date of Birth

Please provide detailed and specific information about the prospective recipient's health condition.

What city and state does the prospective recipient currently reside?

Where is the prospective recipient looking to travel for healthcare?

Is the recipient looking for air or ground transportation?

What is the requested date for the recipient's travel?

Does the prospective recipient need to travel with any medical equipment? YesNo

Will the prospective recipient need a paramedic or nurse present? YesNo

Who will be traveling with the prospective recipient?

Does insurance cover any of the costs for transportation? YesNo

[/group]

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