Transport Request

transport request

The Phillipsburg Emergency Squad is happy to announce that it offers non-emergency transport services to its town residents. This service can be utilized to transport yourself or a family member home from the hospital or extended care facility, transport to a doctors office, or transport them from the hospital to an extended care facility. The Phillipsburg Emergency Squad does bill for this service. Transport request should be requested 72 hours in advance. If you need to schedule a non-emergency transport, please fill out the form below and an Line Officer will contact you as soon as possible.

Transport request form

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Pickup Location *

Line 1

Line 2

City

State

Zip Code

Country

Patient Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Town Resident *

Type of Transport *

How will you be paying *

Date of Transport *

Time of Transport *

Drop off Location *

Line 1

Line 2

City

State

Zip Code

Country

List any steps, ramps, or potential problems here: *

Schedule