Mercury Transport

Non-Emergency Medical Transport

 

  Home    About    Service   Transport    Paratransit    Get a     Schedule    FAQ      Staff       Vehicles
                  Us         Area      Services       Services      Quote     a Pickup
 

    Payment/Insurance/Billing/Medicare/Medicaid                                          Safety   Policies   Packages

   

Schedule a Pickup

in our Geography

 

 

 

 

 

 

 

 

 

 

 

 

Mercury Transport covers much of North Central Ohio, including:

Ottawa, Sandusky, Seneca, Erie Huron and Lorain Counties.

If you don't see your County listed, please contact us to inquire about getting service in your area.

Online Form - Fill in the blanks about the service requested and we will Schedule a Trip based on the data provided.

Please call us at (xxx) xxx-xxxx or fill out the form below to request a Scheduled Service Pickup.

We will contact you soon with a Confirmation and Price. 

* denotes required fields

Online Scheduled Pickup Form

Scheduler's Full Name *:              Scheduler's Phone *:

Patient New or Existing:

Passenger's Full Name *:       Payment Type *:

Type of Injury or Medical Condition:

Type of Transportation Needed *:

Passenger Address *:                    

City: State: Zip*:

Destination Name:      

Destination Address *:

City: State: (2 char) Zip (5)*:

If Recurring, Appointment Frequency:

Date of Pickup: (Format mm/dd/yyyy)

Appointment Time of Day for Pick Up:    

Request Return to Pickup Location? (Default is NO):

Are You Requesting we Wait or be Called Back? (Default is NO):

Email Address *:

Comments:

 

 

 

   
 

Developed by Jlink
Jlink Inc 2018