NEMT Booking Form

Request a Journey Assist Transportation

Submit your details to request a safe and reliable non-emergency medical transportation ride.

Full Name *

Phone Number *

Please enter a valid phone number Email Address

Pick-Up Address *

Drop-Off Address *

Pick-Up Date and Time *

Do you need a return ride? *

Yes No

Services *

Facility / Doctor Name (optional)

Mobility Type *

Door-to-Door Assistance Needed? *

Yes No

Will a caregiver ride along?

Yes No

Preferred Contact Method *

Phone Text Email

Additional Notes (optional)

We've received your transportation request and our team is reviewing it.

You can expect a confirmation shortly via your preferred contact method.

We are committed to providing a safe, reliable, and compassionate ride experience.

If you have any urgent questions or changes, please contact our support team directly.