Schedule a Ride Online

If you are a Medicaid client with a trip request please call:(205) 386-4066 or schedule your ride online:Please schedule at least 48 hours in advance of your appointment to allow us sufficient time to arrange for service.Transportation with less than 48 business hours notice (2 business days) must have a verifiable and valid reason to be scheduled.Your trip must be within 25 miles of the pick-up location. For any miles over 25 please add reason for approval to schedule your service, please have the following information ready:- Your Medicaid ID number, name and date of birth- Type of trip Medicaid, VA, or personal pay- The address where we are picking you up- Your doctor’s name and address as well as a telephone number for confirmation of your appointment.- The date and time of your medical appointment along with an estimated time for any return trip*

Trip Information

Home Pick-up Address

Destination Address

PLEASE NOTE! If you have not submitted a MCTS form you will only qualify for the next available mode of transportation depending on location.

Agreement & Signature

I understand if I have given false information or intentionally failed to disclose information, I may be subject to prosecution, criminal, civil, or both. I certify, under penalty of perjury, that the information provided is accurate to the best of my knowledge. I understand that Hands of Heart Transport does not provide MEDICAL ambulance transports; this is a Non-Medical Transport Service. If Hands of Heart is unable to confirm your appointment within the required 48 hour time frame your transportation request will be denied. DENIED REQUESTS CAN ALWAYS BE RESUBMITTED WITH THE REQUIRED DOCUMENTATION.

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