Book A Ride
Contact Information
First Name
*
Last Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
Trip Details
Pick up address
*
Drop off address
*
Service Date Requested
*
-
Month
-
Day
Year
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Service Time Requested
*
Hour Minutes
AM
PM
AM/PM Option
How many passengers?
*
Is this a Round Trip?
*
Yes
No
Pick up address (round trip)
Drop off address (round trip)
Service Date Requested (round trip)
-
Month
-
Day
Year
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Service Time Requested (round trip)
Hour Minutes
AM
PM
AM/PM Option
How many passengers? (round trip)
Service Type
*
Please Select
Basic Rides ( Everyday / Airport)
Non Emergency Medical Transportation (NEMT)
Specialty Rides
Corporate Transportation
Executive & Secure Transportation
Estimated hours needed? ( Corporate & Executive)
Specialty Options
*
Women-Only Transportation
Child- Friendly Transportation
Autism- Friendly Transportation
Elder Transportation (55+)
Confidential Secured Transportation
Hospital Discharge Ride Assistance
Group Transportation
None
Disclaimers & Acknowledgements
Specialty Transportation Acknowledgment
*
I acknowledge that Specialty Transportation Services are pre-arranged, require manual review and approval, and are subject to availability. I understand that Tailored Transportation Services does not provide medical, therapeutic, custodial, or emergency services. I confirm the passenger is appropriate for non-emergency transportation and does not require medical supervision.
Passenger Care Acknowledgment
*
I acknowledge that Tailored Transportation Services provides transportation only and does not offer supervision, caregiving, or medical assistance. Any special needs, accommodations, or instructions must be disclosed in advance.
Confidential Transportation Acknowledgment
*
I acknowledge that confidential or secured transportation services are provided on a limited, need-to-know basis. I understand that details regarding routes, locations, and driver assignments may be restricted for safety and privacy reasons.
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