Note: If you are a recipient of Medicare or Medicaid, please contact us to determine whether or not your Health Plan is accepted.
Private passengers who would prefer to pay out of pocket or are not recipients of a federally funded program are welcome to use the following form.
Any item with a red asterisk (*) is required. Please allow time for processing.
Once processing for an available time slot is complete, you will receive an invoice via e-mail and confirmation via preferred method of contact.
Invoices must be paid in full up to 24 hours before your trip's scheduled time. Failing to pay on time will result in cancellation. Additional charges may apply.