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Get Physician Consent Form for an Individual Who Needs to Use a Portable Oxygen Concentrator (POC) During an Allegiant Air Flight 2014-2024

On Physician’s letterhead) Physician’s Name: ________________________________________ Place of Business: ________________________________________ Address: ________________________________________ ________________________________________ Telephone: ________________________________________ Fax: ________________________________________ 1. Please note that, in accordance with Special Federal Aviation Regulation (SFAR) No. 106, 14 CFR Part 121, only the AirSep Freestyle, AirSep Lifestyle, D.

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