Life Flight Ride-Along Screening

Life Flight Ride-Along Screening

Name*

Please enter full name, no nicknames

Date of ride-along*

Additional dates available for ride along

Base Preference*

Select

Email address*

Cell Number*

Please enter your height (feet, inches)*

Please enter your weight in pounds*

Please select your profession*

Select

Professional Statement*

In a brief statement, describe your rationale for requesting a ride-along and how it will benefit you professionally.

Are you completely vaccinated for COVID-19?*

i.e. 14 days since second dose of Pfizer/Moderna, or a single does of J&J

Select

I will not be able to care for COVID +ve patients*

I understand and agree that as a ride along I may not be permitted to participate in the care of and transport of known COVID-19 patients

Select

Please contact LF for any concerns/questions*

Please call Life Flight at 919-681-5433 if you have any questions or concerns after completing this form

Electronic Signature*

By filling in your full name below, you are indicating that you have answered truthfully to all of the questions above.

Required Documents*

Please upload proof of Covid vaccination card and driver's License

Drag and drop files here or

Send me a copy of my responses