SERVICE No.(638)FOR
Individual Self Pay
Hospital or medical industry Facility
Select option
ALF Silver Palm
ALF Treasure Isle Care Center
Americas Tours, Inc
AVENTURA HOSPITAL
Baptist
BAPTIST HEALTH HOSPITAL DORAL
Baptist Homestead
Baptist South Miami Hospital
Coral Gables Hospital
Crystal Health & Rehab
Doctors
ENCOMPASS HEALTH REHABILITATION HOSP OF MIAMI
Florida Medical Center (FMC)
HCA FLORIDA UNIVERSITY HOSPITAL
Hialeah Hospital
Kendall Regional Medical Center
KERALTY HOSPITAL
Larkin Community Hospital
LARKIN PALM SPRINGS
Mercy Hospital
North Shore Medical Center
PALMETTO CARE CENTER
Palmetto General Hospital
West Kendall Baptist Hospital
RIDER INFORMATION
First name
The field first name can't be empty.
Last name
The field last name can't be empty.
DOB
The field DOB can't be empty.
Email
The field email can't be empty.
Phone number
The field phone number can't be empty.
PICKUP INFORMATION
Building name
The field building name can't be empty.
Address
The field address can't be empty.
Room # or Suite #
The field room or suite can't be empty.
Pick up time
The field pick up time can't be empty.
TYPE OF SERVICE
Type of mobility
AMBULATORY
WHEELCHAIR
STRETCHER
STAIR CHAIR LIFT
STRETCHER WITH STAIR CHAIR
Services
N/A
BARIATRIC (More than 240 pounds)
OXYGEN
2 LITERS
3 LITERS
4 LITERS
Legs
ONE WAY
ROUNDTRIP
Notes
DROP OFF INFORMATION
Building name
The field building name can't be empty.
Address
The field address can't be empty.
Room # or Suite #
The field room or suite can't be empty.
Book Now