Private-pay non-emergency transportation request

Request a medical ride with clear trip details.

Use this website form to request ambulatory, wheelchair, stretcher, chair-assistance, hospital discharge, senior appointment, or long-distance medical transportation. Your request is sent directly to info@cecimedicaltransport.com.

One-way or round tripSame-day requests reviewedLocal to state-to-stateNo WhatsApp required

Medical transportation request

Fields marked with * are required. CECI will use these details to review the request.

Sent to info@cecimedicaltransport.com
01Your contact information
Preferred response method
02Passenger and service
Trip type *
Include equipment type, dimensions, or weight concerns when relevant.
03Route and schedule
Leave blank for one-way trips or an unknown discharge time.
04Final trip notes
0/1500 characters. Do not include diagnoses, medical records, Social Security numbers, or payment card details.
What happens after submission?

A request becomes a booking only after review

CECI checks whether the requested service matches the passenger, whether the route and timing can be accommodated, and what the private-pay quote should include.

Request received

The form sends your details to info@cecimedicaltransport.com with a unique reference.

Service review

Mobility, transfers, steps, route, scheduling, and vehicle fit are reviewed.

Trip-specific quote

Pricing is based on the actual route, service level, access, wait time, and trip type.

Direct confirmation

CECI contacts you before the transportation is considered scheduled and confirmed.

Reservation questions

Booking request FAQ

Clear answers about confirmation, email delivery, trip details, same-day requests, privacy, and emergency transportation.

Does submitting this form confirm the transportation?

No. The form sends a booking request to CECI Medical Transport. A ride is confirmed only after CECI reviews the route, passenger needs, service level, schedule, vehicle availability, and private-pay quote and then contacts you.

Where is my booking request sent?

The form is configured to email booking requests to info@cecimedicaltransport.com. The requester’s email is used as the Reply-To address so CECI can respond directly.

What information should I include?

Provide complete pickup and destination addresses, the trip date and time, one-way or round-trip preference, passenger mobility, wheelchair or stretcher needs, steps, transfer assistance, escort details, and any waiting or return-time requirements.

Can I request same-day medical transportation?

Yes, you may submit a same-day request. Availability is not guaranteed. Advance booking is recommended for wheelchair, stretcher, chair-assistance, hospital discharge, recurring, and long-distance transportation.

Should I include medical records or a diagnosis?

No. Do not submit diagnoses, medical records, Social Security numbers, payment card numbers, or other unnecessary sensitive information. Only provide transportation, mobility, access, route, and scheduling details needed to review the trip.

What should I do during a medical emergency?

Call 911. CECI provides non-emergency ground transportation and does not replace an ambulance, emergency medical service, medical air transport, or transportation requiring treatment or continuous clinical monitoring.

Need help before submitting the form?

Call CECI Medical Transport to discuss mobility, steps, wheelchair or stretcher needs, discharge timing, or a long-distance route.

CECI Medical Transport provides private-pay non-emergency ground transportation. Form submission does not guarantee availability or confirm a ride.
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