Delta POC Approval and Battery Approval Request

Notice: POC approval and battery approval is free of charge to passenger

Phone: 307-732-0040 or 866-692-0040 Fax: 307-734-2982 oxygentogo.com Email: [email protected]
OxygenToGo® is open for calls between the hours of 7:00 a.m. and 7:00 p.m. Eastern Standard Time, Monday – Friday.

All passengers that anticipate using a portable oxygen concentrator (POC) onboard any Delta flight must follow this process and be cleared by OxygenToGo®. Note: No other form is required for clearance of your oxygen device.

Complete all fields and submit to OxygenToGo® a minimum of 48 hours (excluding weekends) prior to the scheduled flight departure of their first flight.
If OxygenToGo® has not contacted you within 24 hours, please call to verify receipt of your document.
OxygenToGo® will contact the passenger to review next steps.
Once approved, you must bring a copy of this form with you to the airport.

Approved POC: Only an FAA approved POC can be used onboard a Delta flight. “Carry-on only” POC’s are not allowed to be used in-flight. No other oxygen sources are allowed on board Delta flights. You may use your own POC if it is one of the 26 approved units listed on Delta.com or if it has a manufacturer’s label identifying your unit as FAA approved. See example:

If your POC does not bear the required label, the device is allowed to be used on board if the manufacturer and model name are on the list of approved devices.

Passenger Details

Name of passenger using the Portable Oxygen Concentrator (POC):(Required)

First Last

Passenger’s contact phone number(Required)

Secondary Phone

Passenger’s contact email(Required)

Travel Details

If your Flight #’s change but not your Confirmation Number doesn’t: you don’t need to notify OxygenToGo® of this change.

Delta Confirmation Number (Six (6) digits long)(Required)

Departure Date(Required)

Departure Flight #1

(If you only have 1 flight, it is fine to leave #2, 3, 4 flight #’s areas blank.)

Departure Flight #2

Departure Flight #3

Departure Flight #4

Return Date

(Leave blank if no return flights.)

Return Flight #1

Return Flight #2

Return Flight #3

Return Flight #4

POC Device Details

Only FAA approved POC can be used on board. No other oxygen sources are allowed on board Delta flights. A list of approved POC is listed on Delta.com (http://www.delta.com/content/www/en_US/traveling-with-us/special-travelneeds/ disabilities.html) or a manufacturer’s label on the POC will identify if your unit is FAA approved.

Supplier of POC Device(Required)

What is the make and model of the POC(Required)

Other Device Name & Model

Total number of batteries that you have or will be supplied(Required)

Note: The DOT allows up to 150% of flight hours in battery hours.

I the passenger will be using a flow setting of(Required)

The Airline’s pressurized aircraft cabin altitude equals 8,000 feet above sea level

Flow Setting(Required)

Passenger Signature

Date