TRA Ride Request Form

IMPORTANT Please note that submitting this form is a ride request, and not a guarantee of service. Our team will get back to you to either confirm your ride, or let you know if you've been placed on a waitlist. We appreciate your patience!

REMEMBER You must be a registered, approved rider with TRA in order to submit a ride request.

RIDE LIMITS You may request up to two rides per week.

You must be registered as a rider with TRA in order to submit a ride request.

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

What is the DATE of the ride you are requesting? We need at least three business days notice for all ride requests.

Monday through Friday only

What is the name of the DOCTOR you are seeing?

What is the name of the OFFICE or FACILITY you are going to?

What is the ADDRESS of your DESTINATION? Destinations must be in Westchester, Putnam, or Fairfield counties.

Street Address (include suite # if applicable)

Street Address Line 2

CityState

Zip Code

What TIME do you need to be there? (Please tell us the appointment time, NOT the pick-up time.)

9 AM to 5 PM only

AM/PM Option

One way or round trip?

How long will you be at your destination?

Minimum time is 45 minutes. Please enter 45 minutes or longer.

Will you be accompanied by an aide or companion?

What is the name of your aide or companion? All passengers must sign a waiver.

First NameLast Name

Anything else you'd like to share with us?

Our team will get back to you to either confirm your ride, or let you know if you've been placed on a waitlist. We appreciate your patience!

TRA Email

example@example.com