Book a ride

Ride request form

Please submit requests at least 24 hours in advance when possible. Same-day requests are accepted subject to availability.

Submitting this form does not confirm your ride. A Veterans Transit team member must review availability and contact you. Your trip is only scheduled once you receive a confirmation from us. For a medical emergency, call 911.

Requester details

The person completing this form (caregiver, family member, case manager, or the passenger).

Full name

Relationship to passenger

Phone number

Email address

Organization (if applicable)

Passenger details

The person who will be riding.

Passenger full name

Passenger phone number

Date of birth

Escorts or companions riding along

Pickup and destination

Pickup address

Pickup city

Pickup ZIP code

Destination facility or clinic name

Destination address

Destination city

Destination ZIP code

Ride date and time

Ride date

Appointment time

Requested pickup time

Leave blank and we will recommend a pickup time based on distance.

Estimated return / ready time

Round trips only.

Trip type

One-wayPickup to destination only.Round tripReturn ride after the appointment.

Mobility and wheelchair requirements

Mobility level

Wheelchair type (if applicable)

Assistance needed

Equipment traveling with passenger

Walker, cane, oxygen, service animal, etc.

Other medical or accessibility notes

Payment or authorization

Payment or authorization type

Authorization or claim number (if any)

Payer, plan, or billing organization

Consent and acknowledgements

I confirm the information provided is accurate and I am authorized to request transportation for this passenger. (required)I understand that submitting this form is a request only and does not confirm the ride until Veterans Transit contacts me with a confirmation. (required)Veterans Transit may contact me by phone, text, or email about this request and related trip updates. (optional)

Veterans Transit provides non-emergency transportation only and is not affiliated with or endorsed by the U.S. Department of Veterans Affairs. For a medical emergency, call 911.