Book Your Ambulance

To obtain a quote for a long distance ground ambulance transfer, please contact us using this form, or call us at 1-855-614-2533

Name
First Last
Email*
Phone*
I am interested in a quote for:
- Patient Transfer
- EMS Standby
- Ambulance Rental
- Long Distance Ground Ambulance
- Other
Please let us know any additional information about your request:
Patient Transfer
To book service or obtain a quote for a patient transfer, or long distance ground ambulance transfer, please complete this secure online form. Please note, we do not collect private patient or medical information online. Once your transfer has been confirmed, we will contact you to arrange payment information and to confirm your booking details.
Name of Person Requesting
First Last
Transfer From
Transfer To
Date of Transfer
Date Format: MM slash DD slash YYYY
Appointment or Pick Up Time

: HH

MM
Is this a one way transfer, or return after appointment?
Please let us know any additional information about your request, special needs, access or care requirements. This information will be relayed by our dispatch to the patient transfer crew:

Patient Transfer