Request a ride

Tell us where you are going and when. We call you to confirm before anything is booked.

For emergencies, call 911. This form is for planned rides to medical appointments.

This form needs JavaScript, which is turned off in your browser. Please call us at (612) 200-3377 and we will take your request by phone.

Every field is required unless it says optional.

Who is riding

Rider's full name

Phone numberWe call this number to confirm the ride.

Email (optional)

Where and when

Pickup addressStreet address, apartment or unit, and city.

DestinationClinic or building name and address.

Appointment date

Appointment timeThe time the appointment starts.

One way or round trip

One wayRound trip (there and back)

About the ride

How does the rider get around?

I can walkOn my own, or with a cane or walkerI use a wheelchairI need a wheelchair accessible vehicleNot sureWe will talk it through when we call

Number of people ridingCount the rider and anyone coming along.

How will the ride be paid for?

Anything else we should know

Notes (optional)For example: stairs at the entrance, a gate code, or equipment you are bringing. Please do not include medical details or ID numbers. If we need more, we will ask by phone.

Sending this form asks us for a ride. It is not booked until we call you to confirm.