Book a ride

Passengers Name *

First Name

Last Name

Phone

(###)

###

####

Passenger Date of Birth *

MM

DD

YYYY

Passenger Pick-Up Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Passenger Drop Off Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Pick Up Date *

MM

DD

YYYY

Pick Up Time *

Hour

Minute

Second

AM PM

Appointment Time

Hour

Minute

Second

AM PM

Requested Service *

Wheelchair

Ambulatory (Able to walk independently with or without a walker/cane.)

Gurney/Stretcher

How did you hear about us?

Yelp

Google

Social media

Acknowledgment of Non-Emergency Medical Transportation (NEMT) Service *

By proceeding with this booking, you hereby acknowledge and confirm that you are requesting a Non-Emergency Medical Transportation (NEMT) service. This service is intended solely for non-emergency situations nd is not equipped or designed to handle emergency medical situations. If you or someone you know is experiencing a medical emergency, please call emergency services immediately and seek appropriate medical attention. You understand that using this service for emergency situations can result in serious harm or detriment to health due to the lack of emergency medical equipment and immediate response capabilities. By confirming this booking, you agree that you have read, understood, and accepted the terms of this acknowledgment, and you are fully aware of the nature of the service you are requesting. By submitting this form, calling or texting the number (833)736-7372, customers agree to receive text messages. If you no longer wish to receive text messages, you may opt out at any time by replying "STOP".

Acknowledge