"Where Every Ride Is a Journey to Better Health."

Book A Ride

Fill Out The Form Below

Name(Required)

First Last

Phone(Required)

Email(Required)

Type of Vehicle Needed(Required)

Car – Seat up to 5

Van – Seat up to 6 or 7

Wheelchair Accessible Van

Services(Required)

Insurance Authorization/Voucher #(Required)

Insurance ID#(Required)

Insurance Name(Required)

Date of Birth(Required)

Company/Facility Name(Required)

Type of Equipment or Medicine(Required)

Recipient Name(Required)

Appointment Date

Appointment Time

:

Pickup Address(Required)

Street Address Address Line 2

Drop-Off address(Required)

Street Address Address Line 2

Special Instructions(Required)

Round Trip(Required)

Round-Trip

One-Way

Need Pick-up Time or Will Call ?(Required)

Need Pick-up Time

Will Call ?

Appointment Time

:

Please allow up to 1 hour from the time you call for the driver to arrive.

We are your trusted partner for non-emergency medical transportation (NEMT), offering safe, reliable, and compassionate transportation services.

(708) 913-4115

info@samstransitinc.com

15475 S Park Ave., South Holland IL 60473