To submit a complete referral, you'll need the patient's full name, date of birth, address, phone and email; appointment details (date, time, facility name and address, treating physician); patient's medical condition (general information, not detailed medical records); proof of patient's income (tax return, SSI letter, bank statements or pay stubs); appointment verification (letter, portal screenshot or email from medical facility); and patient's mobility status and any special medical needs.

If a patient's income exceeds the standard eligibility limits but they're facing substantial medical debt, we can review the situation on a case-by-case basis. We'll ask for documentation verifying the medical debt, such as billing statements or payment plans. Once received, the request is referred to upper management for review and approval. Our goal is to ensure that patients with genuine financial hardship still have access to the care and transportation they need.

You have two options: Complete the request on behalf of your patient by filling out the online form with the patient's information and required documents, or give the link  directly to the patient or family so they can complete it themselves. Both options are available through our online request system.

Yes! Healthcare professionals can request assistance for their patients. You have two options: Complete the form on behalf of the patient by providing all patient information and required documents, or generate a shareable link to create a unique link/QR code to give to the patient or family so they can complete the form themselves (this protects patient privacy/HIPAA). We understand that social workers and case managers play a crucial role in connecting patients with resources. We've designed our process to make it easy for you to assist your patients access transportation to medical care.