USA & Canada: +1(800)872-6667

International: +1(832)872-2222

SCHEDULE A TRANSPORT

We’re here for you and can schedule a transport 24 hours a day, 7 days a week.

All transports are based on availability; the more notice is provided, the better. We suggest at least 24-48hrs in advance if possible. If your transport is needed in less than 24hrs., please call our dispatch office to provide your details and check for availability.

Schedule A Transport Main

Contact Information

Ex. +1 (999) 999-9999
Ex. +1 (999) 999-9999
Ex. +1 (999) 999-9999
Preferred method of contact

Transport Information

Pick Up Time *
:
Appointment Time
:
Patient Returning? *
If Returning, shall crew wait with the Patient? *
Type of transport *
Air Ambulance/Medical Escort related? *
Is transport needed at origin & destination cities? *
Is the tail # trackable?
Flight medical team transportation needs: *

Section

Departure Time *
:
Arrival Time *
:

Section

Level of medical transport requested *
Cot size *

Patient's Information

Patient directive status

Pick-up Origin

EX. +1 (999) 999-9999

Drop-off Origin

Ex. +1 (999) 999-9999

Pick-up Destination

Ex. +1 (999) 999-9999

Drop-off Destination

Ex. +1 (999) 999-9999
For Wheelchair Van transports; Specify if the patient has his own wheelchair or if he needs one for transport.

Upload related documentation

Relevant to your transport request, the following current documentation is recommended (if available):
• Latest Patient’s Medical Report or History and Physical
• Latest Flight Itinerary (if related to air transportation)
• Latest Test Results including COVID-19
• Memorandum of Transport or Latest Discharge Progress Notes
• Out of Hospital Do Not Resuscitate Order (if applicable)
• Any other relevant documentation
Maximum upload size: 5MB

Each trip is booked as per availability upon signed contract, payment or credit card pre-authorization are received.

Upon receiving your complete schedule request, a medical transportation specialist will check availability and will get back with you with a confirmation number once your transport is booked.

All solutions are provided on a global basis as per the availability at the time of booking. The type of transport, service, and ambulance are according to the stipulations and the information specifically requested by the Customer (the “Trip”). In the event of any change to the Trip, additional charges may apply.

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