Book a Trip
Book a Trip
Enter the name of the passenger here
Booking Agent Contact Information
Please enter the contact information for the person responsible for booking the ride. You must have a valid email address in order to book a ride online. If additional information is required, a service representative will contact you.
Please enter the information about the trip being booked. Try to be as specific as possible. Make sure to include complete addresses and am/pm with times.
Enter the facility name and address of the location where the passenger will be picked up.
Enter the facility name and address of the passengers destination.
Ambulatory $7.50 base rate with $2.50 per mile
Wheelchair $29.50 base rate with $3.50 per mile
Is the passenger visually impaired and require a service anmal?
Does the passenger require oxygen? (2 liters max)
Please include all of the passengers payment information. Do not include credit card numbers. If we require additional payment information, a representative will contact you.
The facility Name on the Private Account
Please include any specifics about the trip not answered above. Do not enter credit card numbers into this box. If we do not have a credit card on file, a representative will contact you to arrange payment.
This field is for validation purposes and should be left unchanged.
5600 Shirley Park DR. Bessemer Alabama 35022
Copyright, Medical Transport of Alabama.
Design by SN