Do not use this form. Use this link: https://app.okridecare.com/?page=transport-request-form&requesterId=GEN-WEB

Thanks for your help in transitioning to our new platform.

 
 

Scheduled trips can be submitted up to five (5) days in advance. Crisis trips are a priority on the day of submission.

 
 
 

CIBD card is not needed.

 

Client Information

 
 

XXX-XX-XXXX

 
 
 
 
 

Referring Information

 
 
 

Dispatchers will call this number to confirm the details of the transport. If no one answers, transport will be delayed.

Phone
 
 

Submitters will receive an automated email to confirm arrival of this form. Dispatchers will call later to confirm the submitted information.

 

Address, plus special information (blue door on the left, south of the dumpster, etc)

 
 

Destination Information

 
 
 

This person will only be contacted if this trip is for in-patient care.

 
Phone
 

Additional Information

 

Examples: Suicide/Self Harm, Elopement Risk, ADA Needs, Triggering Elements

 
 
 
 

Examples: Recurring trip; client needs help getting to the car; excessive luggage; must ride alone; accompanying child; accompanying adult


IF THE CLIENT REQUIRES AN ACCOMPANYING ADULT, please add the name of the adult here.


No extra riders will be allowed unless they are listed here.


Note: Parents must provide an appropriate car seat for children.

 
 
 

IMPORTANT!

We want to thank you for utilizing Ride Care. Our goal is to help you assist your clients with efficient, dependable transportation to their mental health appointments.


As Ride Care continues to grow, so do our processes. Sometimes with a new and innovative system such as Ride Care, hiccups can occur with scheduling. If you experience any type of issue, please call our dispatch center at 800-690-4305. That is the most efficient way of resolving transport issues.