Schedule a Ride - Access Ride - a non-emergency medical transportation provider (NET) - serving Virginia, Maryland and the Washington, DC metro area

SCHEDULE A RIDE
To place a reservation, please complete and submit the online reservation form below, or choose one of the following alternate methods to place a reservation:

Call us at (703) 917-6633 or 1-800-893-2996
Email us at info@access-ride.com
Fax a completed Reservation Form to (703) 723-8401

Reservations should be made at least 24 hours in advance.

Contact Information
Name:
Company:
Address:
City:
State:
Zip:
Work Phone:	Home Phone:
Cell Phone:	Fax:
Email Address:
Reserved by:
Service Information
Service Date (Month/Day/Year):
Service Type:
Facility Name:
Vehicle Type:
Number of Passengers:
Pickup Location:
Pickup Time:	AM PM
Number of Hours:
Drop-off Location:
Drop-off Time:	AM PM
Additional Comments/Information:

Payment Information
Anticipated Payment Method:	Cash
	Credit Card (via Phone or Fax)
	Credit Card (online via PayPal)
	Money Order
	Check

Please do not make any payments until we contact you with a price quote.