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.

Patient

First Name

Middle Name (Optional)

Last Name

Date of Birth

Weight (lbs)

Trip

Pickup Facility or Address

Drop-off Facility or Address

Desired Date

Desired Pickup Time

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

Level of Service

Medical Details

Oxygen Required?

Reason for Transport / Diagnosis (Optional)

Insurance (Optional)

Insurance Provider

Policy Number

Medicare Number

Contacts

Your Name (if not the patient)

Contact Phone

Contact Email (Optional)

We'll email you a confirmation of this request.

Responsible Party Name (Optional)

Responsible Party Phone (Optional)

Anything else we should know? (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.