The non-emergency medical transportation company (253) 336 6444

Sun – Sat 8am-6pm, limited services 24/7

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by Dennis Espinoza | Aug 17, 2021 | 0 comments

We appreciate the willingness of Pegasus to come when we need them. Our patients sometimes must get to the hospital and clinics on short notice and Pegasus is willing to work with our needs.

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REQUEST TRANSPORT

When you complete and submit the booking form, you should receive an auto reply to alert you that we received the request, and we will get back to you with confirmation. Response will come via email once we have fit the trip on our schedule and can provide a pickup time.

Passenger First Name*

Passenger Last Name*

Passenger Height*

Passenger Weight*

Phone*

Contact Email*

Payer Name*

Payment Option

Bill the facility

Passenger is responsible for own transportation costs.

Payment for Private Pay trips must be made prior to travel.

Transport Type

Additional Needs / Special Consderations?

Need to use a Pegasus Wheelchair

Will have an Escort/Extra passenger

Passenger has Oxygen Tank

Name and phone number to contact with questions, or to confirm booking?*

How many trips do you want ?

How many trips do you want ?

Trip Details 01

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, Zip Code*

Room/Suite Number?*

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, Zip Code*

Room/Suite Number?*

Appointment Time*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

Trip Details 02

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, Zip Code*

Room/Suite Number?

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, Zip Code*

Room/Suite Number?*

Appointment Time*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

Trip Details 03

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, Zip Code*

Room/Suite Number?

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, Zip Code*

Room/Suite Number?*

Appointment Time*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

Trip Details 04

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, Zip Code*

Room/Suite Number?

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, Zip Code*

Room/Suite Number?*

Appointment Time*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

Trip Details 05

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, Zip Code*

Room/Suite Number?

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, Zip Code*

Room/Suite Number?*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

This field should be left blank

REQUEST TRANSPORT

When you complete and submit the booking form, you should receive an auto reply to alert you that we received the request, and we will get back to you with confirmation. Response will come via email once we have fit the trip on our schedule and can provide a pickup time.

For passenger
For Facilities

Passenger First Name*

Passenger Last Name*

Passenger Height*

Passenger Weight*

Payer Name*

Payment Option

I will call the office to make payment arrangements.

Please charge my credit card on file.

Email me an invoice and I will pay before the trip.

Payment for Private Pay trips must be made prior to travel.

Transport Type

Phone*

Contact Email*

Additional Needs / Special Consderations?

Need to use a Pegasus Wheelchair

Will have an Escort/Extra passenger

Passenger has Oxygen Tank

Name and phone number to contact with questions, or to confirm booking?*

How many trips do you want ?

How many trips do you want ?

Trip Details 01

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, ZIP Code

Room/Suite Number?

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, ZIP Code

Room/Suite Number?*

Appointment Time*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

Trip Details 02

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, ZIP Code*

Room/Suite Number?

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, ZIP Code*

Room/Suite Number?

Appointment Time*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

Trip Details 03

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, ZIP Code

Room/Suite Number?*

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, ZIP Code

Room/Suite Number?*

Appointment Time*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

Trip Details 04

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, ZIP Code

Room/Suite Number?

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, ZIP Code

Room/Suite Number?*

Appointment Time*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

Trip Details 05

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, ZIP Code*

Room/Suite Number?

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, ZIP Code*

Room/Suite Number?

Appointment Time*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

This field should be left blank

Passenger First Name*

Passenger Last Name*

Passenger Height*

Passenger Weight*

Phone*

Contact Email*

Payer Name*

Payment Option

Bill the facility

Passenger is responsible for own transportation costs.

Payment for Private Pay trips must be made prior to travel.

Transport Type

Additional Needs / Special Consderations?

Need to use a Pegasus Wheelchair

Will have an Escort/Extra passenger

Passenger has Oxygen Tank

Name and phone number to contact with questions, or to confirm booking?*

How many trips do you want ?

How many trips do you want ?

Trip Details 01

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, Zip Code*

Room/Suite Number?*

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, Zip Code*

Room/Suite Number?*

Appointment Time*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

Trip Details 02

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, Zip Code*

Room/Suite Number?

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, Zip Code*

Room/Suite Number?*

Appointment Time*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

Trip Details 03

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, Zip Code*

Room/Suite Number?

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, Zip Code*

Room/Suite Number?*

Appointment Time*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

Trip Details 04

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, Zip Code*

Room/Suite Number?

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, Zip Code*

Room/Suite Number?*

Appointment Time*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

Trip Details 05

Pickup Details

Pickup Location Name*

Pickup Address*

City, State, Zip Code*

Room/Suite Number?

Pickup Date*

Destination Details

Destination Location Name*

Destination Address*

City, State, Zip Code*

Room/Suite Number?*

Drop off notes? (If traveling to residence will someone be there to meet passenger? Name / phone, etc.)

This field should be left blank

Pegasus Lifts remains open and operational during the COVID-19 outbreak. Read our management message and about the extra precautions we are taking here.