Completing the Mobility Aid Input Form

The form is designed to gather important information about your mobility device so that the physical tag can be printed and mailed to you to affix to your device. You will also receive a PDF copy of the tag via email that you can print and take with you when you travel.

Additional information regarding the assistance you need to travel is also gathered so that it can be shared with participating airlines to improve your travel experience.

Completing the Mobility Aid Input Form
Graphic showing Completing the Mobility Aid Input Form
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Mobility Aid Owner Details

Mobility Device owner email address used to provide a PDF version of the tag and provide information about your form

Mobility Device owner cell phone number printed on the physical tag so that an airline employee responsible for loading your device on the aircraft can contact you if necessary once you check the device with them

Full address necessary so that the physical tag can be mailed to you so you can put it on your device

Lift and Transfer Required Informs the airline whether you need assistance to your seat on the aircraft

The number of people required to assist with lift and transfer defaults to two people but allows you to indicate if you need 3 or 4 people to assist you to your seat on the aircraft


Mobility Aid Information

Mobility Device Type specifies whether your device is a manual or battery-operated wheelchair or scooter

Manual Wheelchair

Brake or Wheel Lock Yes or No to indicate if there is a brake on the wheelchair

Battery Operated Wheelchair

  • Dry Cell Battery
  • Lithium Battery
    • If Lithium battery powered, provide watt hours for the battery.
    • If the battery is 300 or more watt hours, then it cannot be transported onboard an aircraft.
  • Wet Cell Battery

Free Wheel Lever Location 

Indicate where on the mobility aid the free wheel lever is located.

  • Front of Base
  • Middle of base
  • Back of Base
  • Tiller

Breaker or Power switch Yes or No if there is a main power switch on the device

Does the seat back fold down? Answer YES if the seatback folds down for storage

Mobility Device Weight provides the weight of the device in either pounds or kilograms. Both metrics will be printed on the physical tag

Mobility Device Length (at its smallest, ready to load on aircraft) measure the length of your mobility device after all detachable parts are removed and it is ready to load in the cargo hold

Mobility Device Width (at its smallest, ready to load on aircraft) measure the length of your mobility device after all detachable parts are removed and it is ready to load in the cargo hold

Mobility Device Height (at its smallest, ready to load on aircraft) measure the height of your mobility after all detachable parts are removed and the seatback is folded down if it can be

Serial Number provide the serial number of your device if you know it

Mobility Device Manufacturer provide the manufacturer of your device

Mobility Device Model the model of the device

Mobility Aid Information
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REMOVABLE PARTS

Storing removable parts in the aircraft cabin can reduce the potential for damage. Indicate which parts of your mobility aid should be removed and stored in the cabin prior to stowage in the cargo compartment.

  • Arm Support
  • Belts or Straps
  • Controls (joystick, etc)
  • Foot Support
  • Head Support
  • Seat Cushion
  • Side Guards
  • Wheels

SIGNATURE

Provide your name and the date to confirm that you want to submit the information about your mobility aid in order to have a tag printed to affix to your mobility aid.

SIGNATURE
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