Inflight medical oxygen request

Dear Customer,

In order for us to make oxygen (O2) arrangements on United flights, this form must be completed and returned to our office as soon as possible to allow adequate time to arrange this service. We are unable to provide oxygen with less than 48 hours' notice prior to travel. Once you complete the traveler information section, your doctor must complete the physician section and fax the form to United.

Please note the following important information:

  • United Airlines offers inflight medical oxygen only on flights between Guam (GUM) and Tokyo Narita (NRT) and flights between Guam (GUM) and Honolulu (HNL).
  • If your itinerary includes another airline, even as a codeshare partner, please contact the operating carrier directly for their oxygen procedure or policy.

For additional information and assistance, please call the United Customer Contact Center at 1-800-UNITED-1 (1-800-864-8331).

To be completed by the traveler





Flight number Travel date Departure time Departing city Arriving city

To be completed by traveler's physician

Dear physician,

Your patient has indicated that oxygen is required to support his or her medical condition during travel. To enable us to make arrangements for your patient's inflight O2, please answer the questions below. After you have completed and signed this form, please fax it to 1-671-645-8417. Your signature authorizes United to administer oxygen at the flow rate indicated in your response. If you need assistance, it's available at 1-800-UAL-MED1 (1-800-825-6331).

We appreciate your time and assistance with this process.

- United Airlines Medical Department

Patient information








Physician information