Our Observer Program
Request a Ride Along

Please complete all information below and submit the form to initiate the request. You will be contacted to schedule a date to observe.

*Name:		Base Requested:
*Dept./Hospital:		ROTOR:	Select One No Preference MF 1 - Columbus MF 2 - Allen Center MF 3 - Wellston MF 4 - Coshocton MF 5 - Lodi MF 8 - New Philadelphia
*E-Mail Address:		MICU:	Select One No Preference MF 11/12 - Columbus MF 15 - Marion MF 16 - Wooster MF 19 - Cleveland
Address:		Contact Phone:
Address Cont.:		Phone Type :	Select One Home Work Cell
City:		Training Level:	Select One EMT RN MD/DO COMM OTHER (Please specify)
State:		Affiliation:	Select One EMS/FIRE HOSPITAL LAW ENFORCEMENT OTHER (Please specify)
Zip:		Weight:
Have you ridden with MedFlight in the past 12 months? Select One Yes No
Comments: * Required information. If you do not have an e-mail address, please contact Jacob Woodward at (614) 204-4658.