Contact – 1premiertransportation

Request a quote

Person Requesting Transport *

First

Last

Email *

Phone *

Relationship to Passenger: *

Passenger Name *

First

Last

Passenger's Weight *

Appointment Date: *

Pickup Address *

Street Address

Street Address Address Line 2 City

State / Province / Region

Postal / Zip Code

Mode of Transportation: *

Check All That Apply *

Round Trip One Way Patient needs Oxygen Has own wheelchair

Special Instructions / Precautions: *

Payment Method: Medicaid, Private Insurance, Medicare,Credit & Debit Cards, PayPal, Venmo, Apple Pay, Google Pay

‍Late Shows: Our drivers will give you a call upon arrival and wait for 10 minutes from your scheduled pickup time. If you’re over 10 minutes late, give us a call right away so that we can schedule our next available driver.

Cancellation Policy: We request at least a 48 hour advance notice for any trip cancellations. Same day cancellations and no-shows will occur a cancellation fee.

* Wait time rates: Wait time is in addition to the calculated trip price and based on your actual return time.