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  • EZRA HEALTHCARE REQUEST FORM

    Thank you for choosing Ezra Healthcare. To book with us, please fill in and submit this Triage form. Please view our Privacy Data Protection Policy at https://www.ezra-healthcare.com/privacy-policy/ By submitting the above details in this form, you agree to us contacting you for the purpose of gathering more information on your query. We may also share necessary data with relevant parties to further address your query/request. We will maintain confidentiality of all personal particulars provided. *NOTE* Medical Transport Request Form is for Non-Emergency patient transport. **FOR URGENT CASES PLEASES CALL DIRECTLY OUR HOTLINE.** Please take note of pick up timing can vary +- 30mins from booking time as and when any exceptional circumstances arise, we will make every effort to fulfill your request.
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  • Number of Family /Medical Personnel    following patient.


  • Additional charges A cancellation charge of 50% of the price may be imposed if you decide to cancel the service after we have arrived at the pick-up point.
    $20 cancellation fees within 24 hours.
    A waiting charge of $15 may be imposed after the first 15mins waiting.
    AED usage $249
    No lift landing additional charge of $20 per flight of stairs

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