• Ambulance Transport Enquiry Form

    For use with Private Ambulance Transport and Repatriation Enquiries
  • About You

    Details of the person making the request
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  • Who's Travelling?

    Details of the Individual Requiring Transport.
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    Pick a Date

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  • Covid-19 Status

    It is important to establish each patient's COVID-19 status before confirming a booking. If it is essential that the patient is accompanied by a parent, carer or comforter, then that person should also be screened at this point. the symptoms listed in the latest NHS case definition of COVID-19 are: (1) A New Continuous Cough (A new, continuous cough means coughing for longer than 1 hour or 3 or more coughing episodes in 24hrs. If the patient usually has a cough, it may be worse than normal. (2) New Fever (High Temperature), (3) New loss of, or change in, sense of smell or taste (anosmia). Please note that during this period, all ambulance crews will be taking extra time and precautions. Having COVID-19 Symptoms does not automatically exclude an individual from transport, but may change how the transport is carried out, to ensure best practice.
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  • The Journey

    Where are they going?
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    Pick a Date
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    Pick a Date
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  • Service User Requirements

    How can we safely and appropriately transfer the service user




  • Payment / Billing Information

    Who will be paying for this transport if Primary Ambulance Services are the approved provider.
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  • Should be Empty:
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