Schedule Transport | Our Savior's Medical Transport

Step 1: Patient & Contact Information

Full Name (Required)

Phone Number (Required)

Email Address (Required)

Step 2: Pickup, Drop-off, and Schedule

Mobility Level Required (Required)

Pick-Up Address (Required)

Drop-Off Address (Required)

Pick-Up Date (Required)

Pick-Up Time (Required)

Step 3: Medical Necessity & HIPAA Consent

Insurance Provider (Optional)

Reason for Medical Transport / Mobility Notes

HIPAA Security Notice & Disclaimer

This booking request is submitted over a secure SSL connection. To protect patient privacy, please limit the inclusion of Protected Health Information (PHI) to basic mobility needs. High-severity clinical files should be transferred directly during our phone verification follow-up.

I verify that this is a request for non-emergency medical transport services. I understand that our dispatch team will follow up via phone to verify details and finalize booking. (Required)

Schedule Medical Transport

Step 1: Patient & Contact Information

Step 2: Pickup, Drop-off, and Schedule

Step 3: Medical Necessity & HIPAA Consent

HIPAA Security Notice & Disclaimer

OSMT Assistant