Request Transport

Complete this form to request medical transportation. Our dispatch team will contact you to confirm details.

Your Privacy Matters

All information submitted through this form is kept confidential, securely transmitted, and handled in accordance with HIPAA guidelines. Your information is used only for purposes related to scheduling and providing transportation services.

HIPAA & Privacy Notice

All patient information submitted through this form is confidential and protected under HIPAA guidelines. Information is accessed only by authorized personnel and shared solely as necessary to coordinate and provide medical transportation and related care services.

Facilities may request a personalized customer portal and QR code to simplify scheduling. To request portal access, contact dispatch at (832) 755-5533 or email info@alertmedicalresponse.net .