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Transportation Form

Transportation Guidelines

  • Transportation for a hospital discharge must be arranged by calling 844-694-2273
  • Pick up times are scheduled a minimum of one hour in advance of appt time.
  • This request form is to be used for requests for medical transport made at least three days in advance, but not more than 30 days in advance. Please Note: Requests received after 3:00 pm on Fridays may not be processed until the following Monday.
  • Transportation is for medical services and appointments only
  • If the appointment requires multiple stops, please call Member Services at 844-694-2273


Our Transportation Form is currently unavailable. Please call Member Services at 844-694-2273 for assistance.