Vermont Medical Transport Resource List

The information collected from this survey will be made available on the Vermont Medical Transportation Resource Dashboard for Vermont healthcare and responders to use to assist with finding non-emergent and interfacility medical transport for patients.


Follow the guidance below based on the transportation services your facility provides (non-emergent vs. emergent/interfacility transfer)

Transportation Service Contact Information

Please complete the following fields for the medical transportation service contact information. Leave answer boxes blank if questions are not applicable.

List the full name of the medical transport service.

Provide the medical transport service phone number. (Please format as shown, ex. 123-456-7890)

Phone

Provide the medical transport service email address.

Provide the street address to the medical transport service.

Provide the full URL/website address to the medical transport service.

Responder Contact Information

Please complete the following fields with your personal contact information in case we need to follow-up.

Provide your first and last name below.

Provide your full email below.

For Non-Emergent Medical Transport ONLY

Please complete the following fields for non-emergent medical transport resources only. Leave answer boxes blank if questions are not applicable.


Non-emergency medical transport refers to transportation services for people who need to get to medical appointments or care, but do not require an ambulance or emergency medical care during the ride. This transportation is often coordinated ahead of time, and dispatch is not utilized for this. This differs from interfacility medical transport, which is defined below.

Select the level of care from the dropdown list that most closely describes the non-emergent medical transport service. (Check all that apply)

Select
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Describe the purpose of service for the non-emergency medical transport service.

Select the hospitals that the non-emergent medical transport serve. (Check all that apply)

Select
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Select the towns that the non-emergent medical transport serve. (Check all that apply)

Select
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Select the distance from the non-emergent medical transports base of operations.

Across Vermont
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List the pick-up/drop off locations for the non-emergent medical transport service.

List the hours of operation for the non-emergent medical transport service.

Describe any necessary requirements to schedule the non-emergent medical transport service.

Describe any eligibility requirements needed to request the non-emergent medical transport service.

For Interfacility Medical Transport ONLY

Please complete the following fields for interfacility medical transport resources only. Leave answer boxes blank if questions are not applicable.


Interfacility medical transport refers to the transfer of patients from one medical facility to another, and is typically staffed by healthcare professionals who provide necessary medical care during the transfer. This differs from non-emergent medical transport, which is defined above.

Select the level of care from the dropdown list that most closely describes the interfacility medical transport service. (Check all that apply)

Select
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Describe the purpose of service for the interfacility medical transport service.

Select the hospitals that the interfacility medical transport serve. (Check all that apply)

Select
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Select the towns that the interfacility medical transport serve. (Check all that apply)

Select
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Select the distance from the interfacility medical transport base of operations.

Select
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List the hours of operation for the interfacility medical transport service.

Describe any necessary requirements to schedule the interfacility medical transport service.

Describe any eligibility requirements needed to request the interfacility medical transport service.

Indicate whether the interfacility medical transport service has internal transport agreements with hospitals, agencies or other organizations.

Select or enter value
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If you selected 'Yes' above, list the hospitals, agencies or other organizations that the interfacility medical transport service has internal transport agreements with.

Additional Considerations for All Transportation Services

Please complete the following fields for the transportation service. Leave answer boxes blank if questions are not applicable.

List the States/jurisdictions outside of Vermont that the medical transport service extends to.

Select the types of seating accessibility options from the dropdown list that the medical transportation service may provide. (Check all that apply)

Select or enter value
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Select whether the medical transport service provides wheelchair accessibility from the dropdown list below.

Select or enter value
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Select whether the medical transport service can assist the patient from curb to facility from the dropdown list below.

Select or enter value
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Select whether and how the driver of the medical transport service can assist the patient from the dropdown list below. (Check all that apply)

Select or enter value
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Select whether the medical transport service accepts Medicaid from the dropdown list below.

Select or enter value
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List the cost per ride for the medical transport service.

List the wait time and/or out of service time costs for the medical transport service.

Provide any additional comments or details that organizations or agencies may need to know in order to use the medical transport service.

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