EMED Patient Care - Private Transfers

Please note, this form is for private, self-funded ambulance transport requests only. If you require NHS funded non-emergency patient transport services, please contact your local booking team using our Find Your Transport Tool.

Get a Private Ambulance Quote with EMED

Please use this form to request a quote for a private ambulance transport with EMED. Once submitted, a member of our team will contact you to confirm availability and pricing. Click "Next" to get started.

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Journey Details

Please provide details about the journey you're requesting. This helps us plan the right transport and ensure we’re ready to support the patient’s needs.

Transport type(Required)

Do you require a wheelchair?

Yes - the patient will provide their own wheelchair

Yes - EMED will provide a wheelchair

No wheelchair required

What type of journey do you need?(Required)

One-way

Return

Please select "Return" if you also need us to bring you back after your appointment or visit.

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Outbound Journey

Outbound Journey Details

Please provide details about the outbound journey to your required destination.

Pick Up Details

In this section, you can provide details of the outbound journey including the date, time, and address for collection.

Please note, your selected pick-up times are the time your transport will arrive for collection. Please factor in any expected delays. Additional waiting time may incur extra charges.

What day should we pick you up?(Required)

What time should we pick you up?(Required)

:

Pick-up address(Required)

This is where the ambulance will collect the patient from.

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Phone number

If available, please provide a phone number for the pick-up address.

Pick-up notes(Required)

Please use this field to share any useful information about the pick-up address. It is very important that you make us aware of any access issues to the property or building.

Upload photos of the property

If there are access concerns (e.g. narrow doorways, steps, or limited parking), you can upload photos to help our team assess the pick-up address. This is optional but can be helpful when planning your transport.

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

Drop-off Details

Please provide details of the drop-off address.

Drop-off address(Required)

This is where the ambulance will take the patient to.

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Phone number

If available, please provide a phone number for the drop-off address.

Drop-off notes(Required)

Please use this field to share any useful information about the drop-off address. It is very important that you make us aware of any access issues to the property or building.

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Return Journey

Return Journey Details

Please provide details about the return journey you're requesting.

Return Details

In this section, you can provide details of the return journey including the date, time, and locations for pick-up.

Please note, your selected collection times are the time your transport will arrive for collection. Please factor in any expected delays, such as clinic overrun. Additional waiting time may incur extra charges.

What day should we pick you up?(Required)

What time should we pick you up?(Required)

:

Pick-up address(Required)

This is where the ambulance will collect the patient from.

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Phone number

If available, please provide a phone number for the pick-up location.

Pick-up notes(Required)

Please use this field to share any useful information about the pick-up address. It is very important that you make us aware of any access issues to the property or building.

Destination Details

Please provide details of the destination location including address and contact number if available

Drop-off address(Required)

This is where the ambulance will take the patient to.

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Phone number

If available, please provide a phone number for the drop-off address.

Drop-off notes(Required)

Please use this field to share any useful information about the drop-off address. It is very important that you make us aware of any access issues to the property or building.

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Patient Details

Tell us about the patient who will be travelling. Accurate information helps us ensure safe and appropriate care during the journey.

Patient's name(Required)

First Last

Patient's date of birth(Required)

NHS number(Required)

Patient's GP practice(Required)

GP practice name GP practice postcode

Patient's home address(Required)

Same as pick-up address (outbound journey)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

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Medical & Booking Information

Let us know about any medical needs, special requirements, and who we should contact to confirm the booking. A member of our team will be in touch once we receive your request.

Medical needs and notes(Required)

Please include relevant medical conditions, diagnoses, mobility concerns, or any care needs during the journey (e.g. dementia, seizures, infection risk, etc.).

Does the patient require Oxygen?(Required)

Yes

No

Patient's weight (kg)(Required)

Extra information(Required)

Use this field for any other useful details such as specific equipment required, preferred timings, or anything else you'd like us to know.

Are you making this booking on behalf of yourself or someone else?(Required)

Myself

Someone else

Your name(Required)

First Last

Relationship to the patient(Required)

Your email(Required)

Your phone

How would you like us to contact you(Required)

If you would prefer us to call you, please ensure you have provided a phone number above.

Privacy policy(Required)

I have read and agree to the privacy policy

Review Your Booking Request

Please review the information you've entered below to make sure everything is correct before submitting your request.

If you need to make any changes, use the “Previous” button. When you're ready, click “Submit” to send us your booking request.

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What happens next?

Once you click "Submit", a member of our team will review your request and contact you to confirm availability, provide a quote, and discuss any specific arrangements required.