Request a Ride

Submit your trip details and we'll confirm your ride within one business day.

Prefer to call? Reach us at 1-877-2-MEDRIDE (1-877-263-3743), Monday through Saturday, 6 AM to 8 PM.

1. Passenger Information

First Name *

Last Name *

Date of Birth

Mobility Level *

Special Needs or Notes

2. Contact Information

Phone Number *

Email Address

Your Relationship to Passenger

3. Trip Details

Trip Type *

Appointment Date *

Appointment Time *

Payment Method *

Pickup Address *

Destination Address *

4. Additional Information

Additional Notes

How did you hear about us?

I understand that this is a ride request, not a confirmed booking. Premier Medical Transit will contact me to confirm availability, pricing, and scheduling. I understand the cancellation policy requires 24-hour notice. *

We will contact you within one business day to confirm your ride. For same-day or urgent requests, please call 1-877-2-MEDRIDE directly.