Transport Request

Non-Emergency Transportation Request Form

  • Our system will automatically send a confirmation email, please check the spam folder if e-mail is not received in the inbox. If transportation request time is less than 24-hours from the pick-up time call us immediately to assist you at (571)970-1828 or TEXT (410)294-7449. This form is for us to have easy access to your information and no-guarantee of transportation unless confirmed by Uniquehands dispatcher.
  • PERSONAL INFORMATION

  • MEDICAL DOCTOR/FACILITY INFORMATION

  • Cancelations should be submitted no later than 24 hours prior to scheduled pick-up.
 

Verification