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Patient/Parent/Guardian of Patient 

Click the link below to view, fill and sign our waiver

Request Our Services

Flying Wings of Louisiana is always eager to help those who are in need. Fill out the form with the important information we need and we’ll contact you as soon as possible!

Requestor's First & Last Name*
City & State*
City & State*
Visiting Hospital/Clinic Name*
Patient's Name*
Including luggage weight
Emergency Contact's Name & Phone #*
Companion's Name*
Including luggage weight
Doctor's Name*
If you have any further information or comments, please let us know:
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Thank you!