* At this time, Medtransit does not take any form of insurance for payment of services. If a trip is booked, we ask that payment be made in advance by credit card. Thank you! "*" indicates required fields Name* First Last Email Phone*Vehicle Type*SedanWheelchairStretcherRound-trip*YesNoService For*Pick-UpAppointmentTime* Hours : Minutes AM PM AM/PM Date* MM slash DD slash YYYY Pickup Address* Dropoff Address* MilesHiddenGeocoderHiddenGeocoderHiddenDirections, Distance & RoutesRouteMapComments / Special Instructions Δ