Schedule a Ride

Trip Fee Estimator

Rider Info - Step 1 of 3

Rider Information

Who will we be transporting?

Rider Name *

First

Last

Rider Phone *

Can this phone receive text messages? *

Rider Email *

Contact Information

What number should we call in the event of traffic problems or locating rider? *

Use the rider's contact information
Enter separate contact information

Billing Information

Billing Contact Name *

First

Last

Billing Contact Phone *

Billing Contact Email *

Billing Contact Address *

Address Line 1

Address Line 2

City

State

Zip Code

Would you like us to bill a saved credit/debit card?

Yes
No, Please contact me for updated billing info.

If you do not have a card on file with us, you can skip this question.

Comments / Special Needs - Is there anything you'd like us to know to make your trip more comfortable? *

NOTE: We do not provide oxygen, but can transport if rider has their own portable oxygen tank

How did you find us? *

Terms and Conditions

We must be notified at time of booking or up to 24 hours before scheduled pickup time of any rider that is suspected or known to be COVID-19 Positive. *

I understand and agree to Sovereign Medical's scheduling conditions

Trips must be requested no less than 48 hours in advance and cannot be guaranteed until we can confirm the trip fits in our schedule. More immediate needs may be scheduled by phone only, and depends upon schedule availability. Please be aware that our schedule fills quickly. We will always do our very best to serve you! (copy) *

I understand and agree to Sovereign Medical's scheduling conditions

When we receive your trip request our scheduling dept will contact you to confirm your trip details. We cannot guarantee that your trip can be scheduled until it is confirmed by our scheduling dept. You may also contact us via email or phone, but keep in mind that we do often experience a high call volume, so please leave a message if we cannot answer your call. *

I understand that Sovereign Medical must contact me before my trip is confirmed.

Cancellations must be made no less than 24 hours in advance. Last minute cancellations (less than 24 hours) will result in a fee equal to the first pick up fee plus 50% of return (if round trip). No shows will be billed at full current pick up rates for both legs of the trip. Any trips that are canceled within a 24 hour period and rebooked for a later date will be subject to a 50 dollar rescheduling fee. When your trip is scheduled we cannot fill that space if it is vacated last minute. *

I understand and agree to Sovereign Medical's cancellation terms

Payment arrangements must be made in advance once trip is confirmed. Please note applicable cancellation/no show policies listed above. Credit Card Processing Fee: 5% of total transaction is Non-Refundable and is applied to charge and refund transactions *

I understand that payment arrangements will be made after my trip is confirmed

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