OMBI NON-MEDICAL TRANSPORTATION LLC

ONLINE RESERVATION

Up to 20% Off at Online Booking for Wheelchair/Stretcher Van and Ambulatory Services

Main Patient's Name *

Number of Passangers in Total *

Transportation type*

Email* We'll never share your email with anyone else.

Phone Number *

Which facilities do you need during tansportation? *

Pickup time *

Date of Pickup:*

Pickup Address *

DropOff Address *

Patient’s Weight (300lbs+ requires bariatric transport team) *

Is the patient COVID Positive or has been exposed to the virus in the past 2 weeks? *

Does passenger need oxygen tank? (Oxygen must be administered by the caregiver) *

Are there any stairs involved to bring the patient downstairs? If yes, how many? *

Who is paying for the trip?

Comments

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