Facility Booking

Schedule patient transportation on behalf of your facility. Our team will confirm each request.

Facility Contact Information

Facility Name *

Facility Contact *

First Name *

Last Name *

Facility Contact Phone (Used for Confirmations) *

Facility Contact Email (Used for Confirmations) *

Booking Information

Trip Type *

One wayRound trip

Pickup Location (Please Include Suite, Floor, Unit, if applicable) *

Include suite, floor, unit, or room number if applicable.

Drop off Address (Please Include Suite, Floor, Unit, if applicable) *

Include suite, floor, unit, or room number if applicable.

Floor / Suite / Department Specialty (if applicable)

Pickup Date *

Pickup Time *

Appointment Time *

Estimated Return Pickup (round trip only)

Patient's First Name *

Patient's Last Name *

Additional Notes / Instructions (if applicable)

Billing Information *

Facility payPatient pays

Transport by *

Acknowledgments

I confirm that all booking information submitted is accurate and complete. I further understand that any same day cancellations will be subject to a cancellation fee. *

I Agree

I understand that Baker's Transit exclusively accepts Facility and Private Pay and does not participate in any insurance programs. *

I Agree

Need help? Call (510) 432-6417