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Book Your Transport Online

Welcome to EMED Patient Care’s online patient transport booking request form.

If you’ve booked transport with us before and you’re registered with a GP in Nottinghamshire, you can now submit your transport request quickly and securely through this form.

What you’ll need to complete your booking request:

NHS Number and patient details (including GP name and address)
Date and time of the appointment
Appointment location (including ward, clinic, or department if needed)

Please do not proceed unless you have these details to hand.

Please note: This booking request form is for patients registered with a GP in Nottinghamshire only. If this is your first journey with EMED, you must call our booking teams to register your details before you can use this form.

All bookings are subject to eligibility criteria. If you’re unsure about your eligibility or need assistance, please call our team on 0330 380 0570.

Before you begin, please make sure you read and agree to our Privacy Policy .

I have read and agree to the privacy policy

Have you booked transport with us before?

Is your appointment within the next 7 days?

Please note we can only accept bookings for appointments within the next 8 weeks

Is the patient travelling for an oncology or renal treatment/procedure?

Does the patient have access to their own vehicle or access to family or friends that can help them travel to their appointment?

Travel Requirements

For patient safety and to ensure the right level of care, please confirm if any of the following apply to this booking:

The patient requires medical gases during the journey (e.g. oxygen)
The patient needs to travel alone for medical reasons (e.g. infection risk, immunity concerns)
The patient must remain lying down for a medical reason during the journey
A bariatric vehicle is required (e.g. if the patient weighs over 120kg)
There are steps or stairs at the property that require lifting or carrying assistance
The patient is confined to their own wheelchair throughout the journey
The patient will experience significant side effects from treatment that make other transport unsafe
The patient suffers from mental health conditions (excluding Alzheimer's disease or dementia)

Do you require any of the above?

Yes

Call Back

Due to the nature of the patient's requirements, we will need to contact you to discuss the booking further. Please provide your contact details below and we will be in touch...

Name

First Last

NHS Number

Phone

Contact Preference

Phone

Patient Details

Are you booking on behalf of yourself or someone else?

Your Name

First Last

Relationship to patient

NHS Number

Name

First Last

Date of Birth

DD slash MM slash YYYY

Gender

Phone

Please select the patient's preferred contact method

Address

Address Line 1 Address Line 2 City County Post Code

Disabilites

None

Amputee

Angina

Anxiety

Arthritis

Asthma

Auditory Impairment

Autism

Breathing Difficulties

C Diff

Cancer

Confusion

COPD

Dementia

Diabetes

DVT

Epilepsy

Heart Problems

History of Falls

Incontinent

Lack of mental ability

Lack of mobility

Language Difficulties

Learning Difficulties

Learning disability

Mental Health

Mental Illness

MRSA

MTA

Multiple Sclerosis

Musculoskeletal Disorders

Non-cognitive

Osteoporosis

Parkinsons

Renal Failure - regualr dialysis

Sensory Neuropathy

Short Term Memory Loss

Speech Impediment

Stroke

Tracheostomy

Visual Impairment

This field is hidden when viewing the form

Disabilities - old

Please select all that apply

Patient Mobility

Please Select patients' mobility

Please select from the following options that best describe your mobility

The patient can get in or out of a car unassisted

The patient requires a higher vehicle or walking aids

The patient can transfer from one wheelchair to another with the help of 1 person

The patient requires the assistance of 2 people in order to move

Does the patient suffer from mental health conditions, excluding dementia/alzheimers?

Yes

Does the patient require a medical escort?

An escort can be a family member or carer. They are only permitted to travel if there is a medical reason they are needed during the journey.

Yes

Journey Details

Has the patient's GP practice changed since they last travelled with us?

Yes

GP Name

Town/City

County

GP Address

Address Line 1 Address Line 2 City County Post Code

If you do not know the address of your GP, please use this link .

Eligibility Criteria

Is this a recurring appointment?

Yes

Which day(s) of the week does this appointment occur?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Does this repeat until further notice?

Yes

How many weeks will this repeat for?

Please enter a number from 1 to 52.

Any other relevant information

What type of appointment is the patient attending?

Outpatients

Admission

Date of appointment

DD slash MM slash YYYY

Time of appointment

Hours

Minutes

Estimated Return Time

Hours

Minutes

Is the collection address the same as their home address?

Yes

Address

Address Line 1 Address Line 2 City County Post Code

Does the patient require lifting or carrying at the property?

Yes

How does the patient access their property?

Stairs

No steps, stairs, or ramp

Steps

Steps outside the property

Stairs outside the property

Hospital or clinic name

Department

Hospital or clinic address

Address Line 1 Address Line 2 City County Post Code

Your Submission

{all_fields:nohidden}

Unfortunately,
we can only accept bookings through this platform from patients who have travelled with us before.

If you would like to make a booking for patient transport,
please contact our team on 0330 380 0570.

Relay users can book their transport using the Relay app
or can dial 18001 0330 380 0570 from a textphone.

Unfortunately,
we can only accept bookings for appointments that are more than 7 days away.

If you would like to make a booking for patient transport,
please contact our team on 0330 380 0570.

Relay users can book their transport using the Relay app
or can dial 18001 0330 380 0570 from a textphone.

Unfortunately,
You don't seem to be eligible.

Sorry, but based on your responses it doesn't look like you're eligible to use this patient transport service.

If you think this is a mistake, please contact our team on 0330 380 0570.

Relay users can call us by using the Relay app
or can dial 18001 0330 380 0570 from a textphone.

By submitting this form, you confirm that the information provided is accurate to the best of your knowledge. Any personal data you share will be handled in line with EMED Group’s Privacy Policy.

If you have any issues with this survey, please contact marketing@emedgroup.co.uk.

None
Amputee
Angina
Anxiety
Arthritis
Asthma
Auditory Impairment
Autism
Breathing Difficulties
C Diff
Cancer
Confusion
COPD
Dementia
Diabetes
DVT
Epilepsy
Heart Problems
History of Falls
Incontinent
Lack of mental ability
Lack of mobility
Language Difficulties
Learning Difficulties
Learning disability
Mental Health
Mental Illness
MRSA
MTA
Multiple Sclerosis
Musculoskeletal Disorders
Non-cognitive
Osteoporosis
Parkinsons
Renal Failure - regualr dialysis
Sensory Neuropathy
Short Term Memory Loss
Speech Impediment
Stroke
Tracheostomy
Visual Impairment

Booking Form Test

Test Booking

Book Your Transport Online

Welcome to EMED Patient Care’s online patient transport booking request form.

If you’ve booked transport with us before and you’re registered with a GP in Nottinghamshire, you can now submit your transport request quickly and securely through this form.

What you’ll need to complete your booking request:

Please do not proceed unless you have these details to hand.

Before you begin, please make sure you read and agree to our Privacy Policy .

Travel Requirements

For patient safety and to ensure the right level of care, please confirm if any of the following apply to this booking:

Call Back

Due to the nature of the patient's requirements, we will need to contact you to discuss the booking further. Please provide your contact details below and we will be in touch...

Patient Details

Patient Mobility

Journey Details

If you do not know the address of your GP, please use this link .

Eligibility Criteria

Your Submission

Unfortunately, we can only accept bookings through this platform from patients who have travelled with us before.

If you would like to make a booking for patient transport, please contact our team on 0330 380 0570.

Relay users can book their transport using the Relay app or can dial 18001 0330 380 0570 from a textphone.

Unfortunately, we can only accept bookings for appointments that are more than 7 days away.

If you would like to make a booking for patient transport, please contact our team on 0330 380 0570.

Relay users can book their transport using the Relay app or can dial 18001 0330 380 0570 from a textphone.

Unfortunately, You don't seem to be eligible.

Sorry, but based on your responses it doesn't look like you're eligible to use this patient transport service. If you think this is a mistake, please contact our team on 0330 380 0570.

Relay users can call us by using the Relay app or can dial 18001 0330 380 0570 from a textphone.

Unfortunately,
we can only accept bookings through this platform from patients who have travelled with us before.

If you would like to make a booking for patient transport,
please contact our team on 0330 380 0570.

Relay users can book their transport using the Relay app
or can dial 18001 0330 380 0570 from a textphone.

Unfortunately,
we can only accept bookings for appointments that are more than 7 days away.

If you would like to make a booking for patient transport,
please contact our team on 0330 380 0570.

Relay users can book their transport using the Relay app
or can dial 18001 0330 380 0570 from a textphone.

Unfortunately,
You don't seem to be eligible.

Sorry, but based on your responses it doesn't look like you're eligible to use this patient transport service.

If you think this is a mistake, please contact our team on 0330 380 0570.

Relay users can call us by using the Relay app
or can dial 18001 0330 380 0570 from a textphone.