Schedule Transport

Schedule Ambulance Transport

BLS, ALS, or stretcher transport with a medical crew. Our dispatch team will call you to confirm every detail before the trip.

Just need a ride without medical care? Schedule NEMT instead. For life-threatening emergencies, call 911.

Fields marked (required) must be filled in.

Patient

First Name(required)

Middle Name (Optional)

Last Name(required)

Date of Birth(required)

Weight (lbs)(required)

Trip

Pickup Location(required)

FacilityAddress

City(required)

State(required)

Zip Code(required)

Drop-off Location(required)

FacilityAddress

City(required)

State(required)

Zip Code(required)

Appointment (if this trip is for one)

Appointment Date (Optional)

Appointment Time (Optional)

Pickup Date(required)

Pickup Time(required)

Will call — no set pickup time; we'll call dispatch when the patient is ready

Level of Service(required)

Need wheelchair, stretcher, or ambulatory transport without a medical crew? Use the non-emergency (NEMT) form.

Medical Details

Oxygen Required?(required)

Reason for Transport / Diagnosis (Optional)

Insurance (Optional)

Insurance Provider

Policy Number

Medicare Number

Contacts

Your Name (if not the patient)

Contact Phone(required)

Contact Email(required)

We'll email you a confirmation of this request.

Responsible Party Name (Optional)

Responsible Party Phone (Optional)

Dispatch Notes (Optional)

I agree to receive SMS text messages from Medtrek Ambulance at the phone number provided, with updates about my transport request (scheduling and status) (no marketing messages). Message frequency varies. Msg & data rates may apply. Reply STOP to opt out, HELP for help. Consent is not a condition of purchase or of receiving services. See our SMS Terms & Privacy Policy.

Prefer to book by phone? Call (239) 228-7900 — 24/7.