Request a Dallas-Fort Worth Medical Ride

STEP 01 / YOUR JOURNEY

What can we help with?

Choose your serviceNon-emergency medical transportAvailability and assistance confirmed before booking.Wheelchair-accessible vanAvailability and assistance confirmed before booking.Private vehicleAvailability and assistance confirmed before booking.Medical package transportPackage details reviewed before acceptance.

Primary passenger name

Pickup locationDestinationPickup entrance accessDestination entrance accessTrip arrangementReason for transportation

Mobility / access needs

Wheelchair riders

Riders using walkersGuest passenger (one seated guest allowed)

For a package, the owner must confirm that the item and required handling are supported. For a passenger, share access needs without a diagnosis or medical history.

STEP 02 / YOUR SCHEDULE

When would you like to go?

Base rates apply weekdays from 6 AM to 6 PM Central, excluding holidays. Night, weekend, and holiday premiums apply. Choose a date to see available pickup windows. Schedule at least 2 hours ahead. Evening and weekend requests can be selected and require owner approval.

Preferred pickup dateAvailable pickup time (Central)

Choose a date to load pickup times. A minimum 2-hour lead time is required.

Appointment time (optional)

STEP 03 / YOUR CONTACT

Who’s arranging the ride?

Contact namePhone numberEmail (optional)I am arranging this forPayment arrangementPreferred payment method

Medicaid and Veterans Affairs inquiries require confirmation of program arrangements and authorization. This form does not determine coverage. Private-pay quotes are confirmed before booking.

STEP 04 / REVIEW

Let’s check the details.

I understand this is a non-emergency request. Availability, service suitability, price, and any payment authorization must be confirmed by the owner.

A ride request.
A thoughtful next step.

What can we help with?

When would you like to go?

Who’s arranging the ride?

Let’s check the details.

Your request is ready for review.

A ride request.A thoughtful next step.

What can we help with?

When would you like to go?

Who’s arranging the ride?

Let’s check the details.

Your request is ready for review.

A ride request.
A thoughtful next step.