Each patient is very special to us. From the moment you submit a request, our PFC prayer partners begin praying for your specific need.
Instructions to Patients:
Step 1: Please download the two-page Patient Request Form below. This is a fillable form that you can either complete on your device and provide an e-signature or print out and sign by hand. After completing both pages, please email your signed form to info@pilotsforchrist.net. In that email, please share with us your story and also send us a picture of yourself and/or your caregiver.
Step 2: If you have a caregiver that you will be requesting to fly with you, please have your caregiver follow the “Instructions to Caregivers” below to fill out the Caregiver Hold Harmless Form.
Step 3: The Physician’s Evaluation Form – Please have your physician follow the “Instructions to Physicians” below to fill out the Physicians Evaluation Form. You can also print out this form for your physician to sign by hand.
Step 1: Please download the two-page Patient Request Form below. This is a fillable form that you can either complete on your device and provide an e-signature or print out and sign by hand. After completing both pages, please email your signed form to info@pilotsforchrist.net. In that email, please share with us your story and also send us a picture of yourself and/or your caregiver.
Step 2: If you have a caregiver that you will be requesting to fly with you, please have your caregiver follow the “Instructions to Caregivers” below to fill out the Caregiver Hold Harmless Form.
Step 3: The Physician’s Evaluation Form – Please have your physician follow the “Instructions to Physicians” below to fill out the Physicians Evaluation Form. You can also print out this form for your physician to sign by hand.
Instructions to Caregivers: Please download the caregiver hold harmless form below. This is a fillable form that you can either complete on your device and provide an e-signature or print out and sign by hand. After completing the form, please email your completed form to info@pilotsforchrist.net.
Instructions to Physicians: Please download the physician evaluation form below. This is a fillable form that you can either complete on your device and provide an e-signature or print out and sign by hand. After completing, please email your signed form to info@pilotsforchrist.net. It is also acceptable to email your form to the patient directly as long as the patient is able to forward the originating email to Pilots for Christ for verification.
If you have any questions, feel free to give us a call at 251-575-9425, or send us a message from our contact page.