WheelCare Transportation4517 34thLubbock, TX 79410ph: 806-794-7573alt: firstname.lastname@example.org
We have added this page in an attempt to make it even easier for our customers to schedule appointments.
This form should be used ONLY to set up appointments that are being made in advance. If you need immediate (within 24 hours) or after-hours transportation, we ask that you contact us at 806-794-7573. (After-hours transportation includes rides between 7pm and 7am. )
After you submit the appointment form below we will contact you to confirm.
Transportation has not been scheduled unless you receieve confirmation.
Please select one of the trips from the drop-down menu. If you need a service other than what is listed, please specify in the "Additional Service Instructions" area at the bottom of the form.
*PLEASE BE READY 45-60 MINUTES IN ADVANCE OF YOUR APPOINTMENT TIME FOR ALL LUBBOCK RIDES*
Please enter the name of the business (if applicable) and the address of the location where the passenger is to be picked up. If you are scheduling a Round Trip than the passenger will be returned to this address.
Please enter the address of the location where we will be taking the passenger.
*If you chose other, please describe in the "Additional Service Instructions" area below
Checking an option above means that you wish for WheelCare to provide this item for the patient at the time of service. You may select more than one. If NO items are selected than it will be assumed that the patient will provide their own wheelchair.
Please add any other information that we may need to know before transporting the passenger.
Please enter your name.
We will call you to confirm the appointment.
Because service provided varies by passenger, you will be quoted a price when we call to confirm.
If we are billing you for your transportation, please enter your billing info above.
Thank you for your business.
Copyright 2009 WheelCare Transportation. All rights reserved.
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