European Air Ambulance

Please use this form only to request a quotation. If you are looking for information about our organisation or this website, use this form.
If you have questions regarding the quotation you can contact our Mission Control Centre 24/7 under the following telephone number: +49 711 7007 7007

All European Air Ambulance missions are subject to the EAA Terms & Conditions. They are are available in English, German and French.

Contact person
Company*
Phone
Fax
Email*
Expected start of mission date
Expected start of mission time
Patient´s location
Destination
Sea level flight
Additional person (e.g. relative)
Double stretcher (if yes, please fill in a form for each patient)
Date of birth or age
Weight (kg)
Height (cm)
Width greater 60 cm (if available)
Main diagnosis
Concomitant disease(s)
Present treatment (Ventilation? Drugs? Oxygen?, Antibiotics? Drainages? etc.)
Infectious disease
High-risk pregnancy
Pediatric patient
Psychiatric disease
Terminal patient
Traction device
External pacemaker
Incubator
Intracranial pressure monitor
Other special devices