Elite Air MEDIF Form

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Elite Air – Medical Information (MEDIF) Form

This form must be completed if you require medical clearance or special assistance when traveling with Elite Air. Please return the completed form to the MEDA Team at least 72 hours before departure.

Part A – Passenger Information

• Full Name:

• Date of Birth:

• Booking Reference / Ticket Number:

• Contact Number:

• Email Address:

• Flight Number(s) & Date(s):

• Accompanying Person(s), if any:

Part B – Medical Information (to be completed by the attending physician)

1. Medical Diagnosis / Condition:

2. Is the passenger fit to travel by air?

YesNo

3. Is medical clearance required?

YesNo

4. Special Requirements:

Wheelchair assistance:

YesNo

Oxygen required onboard:

YesNo

Medical equipment to be carried:

YesNo

Other (please specify):

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5. Is the passenger able to travel unassisted?

YesNo

6. Does the passenger require a medical escort/nurse?

YesNo

Part C – Physician's Details

• Physician's Full Name:

• Medical License / Registration Number:

• Address:

• Telephone:

• Email:

• Signature & Date:

Part D – Elite Air Use Only (to be completed by MEDA Team)

• Clearance Granted:

YesNo

• Special Arrangements Confirmed:

YesNo

• Notes:

• Approved By:

📧 Submission:

Please email the completed form to MEDAteam@eliteair.com at least 72 hours before departure.

ELITE AIR

إيليت للطيران

Elite Air MEDIF Form

Elite Air – Medical Information (MEDIF) Form

Part A – Passenger Information

Part B – Medical Information (to be completed by the attending physician)

Part C – Physician's Details

Part D – Elite Air Use Only (to be completed by MEDA Team)