New Trip Intake

Request a Ride

Tell us about the trip. A dispatcher will confirm by phone within 2 hours. For same-day urgent requests, please call directly.

Patient

First name *Last name *Phone *Email

Remember my info on this device so I don't have to re-enter it next time.

PickupPickup address *

Building / Doctor's office / Suite (optional)

Building name, doctor or facility name, suite, gate code, or pickup notes.

City *Date *Pickup time *

Appointment time (drop-off arrival)

When the patient needs to be at the destination.

Drop-offDrop-off address *

City *

Enter a Florida pickup ZIP and drop-off to see an Estimated Trip Total.

Transport details

Black Tie TransportationPremium chauffeured service for airports, weddings, corporate events, and special occasions. Manually quoted — no automatic pricing.

Trip type *

Single pickup to a single drop-off.

Trip legs preview

Live summary — 1 leg total

Pickup
— · —
From —
To —

Mobility notesSpecial instructions

Recurring trip

Schedule the same trip on a repeating basis (e.g. weekly dialysis). Leave as "One-time" for a single ride.

Repeat

Billing informationUse same information as account holder

By submitting you agree to be contacted about this trip. We never share patient info.