Worldwide Medical Evacuation
 
24-Hour Emergency Hotline
 
Transport to Hospital of Choice
 
Guaranteed Hospital Admission
 
Medical Monitoring & Consultation
 
Guaranteed Return of Spouse
 
Foreign Language Translation
 
Medical & Legal Referrals
 
Medical Record Transfer
 
Guaranteed Return of Spouse
   
 
 
 
 
To schedule a medical transport flight or to receive more information about our air transport services, please fill out the form below. We will get back to you by telephone or by email as soon as possible. Thank you for your interest in GERMAZIN Air Ambulance.
   
Transfer Type  
   Immediate
Future
Info Only
   
Transfer Date
This transfer is for An Individual       A Company
   
Name
Company
Street Address
City
State
Country
Zip Code
Telephone
Fax
Email
Relationship to Patient
     
Have you used our services before? Yes      No
Please give a diagnosis of the patient:
Which services will you need? Air Ambulance
Commercial Stretcher
Medical Escort
Number of additional persons
Transfer FROM:
Name of Hospital / Order
City
State / Country
Tranfer TO:
Name of Hospital / Order
City
State / Country
How did you hear about us?
Please specify Name, type, or Other.
Please add any additional comments
     
 
 
 
 
       
 
 
     
 
 
 
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