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Reliable Non-Medical Transportation

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We remove barriers to care by providing safe, professional transportation for our patients. Because SPRAVATO® requires a 2-hour monitoring period and patients cannot drive themselves home after treatment, we offer this service to ensure you can receive the care you need without stress.

Door-to-Door Service

We pick you up and drop you off directly at your residence.

Safety First

Our drivers are trained in medical transport protocols.

Kare For You Mental Health and Wellness

Non-Emergency Medical Transportation Request Form

SECTION 1: PATIENT INFORMATION

Date of Birth
Month
Day
Year

Emergency Contact

SECTION 2: APPOINTMENT DETAILS

Appointment Time:
Time
HoursMinutes
Pickup Time (if known)
Time
HoursMinutes

Drop-off Location:

Kare For You Mental Health and Wellness

3737 N Meridian Street Ste 401

Indianapolis, IN 46208

Return Ride Needed?
Yes
No

SECTION 3: TRANSPORTATION NEEDS

Do you require assistance entering or exiting the vehicle?
Yes
No
Will you be traveling with a caregiver or companion?
Yes
No
Do you use any mobility aids?

SECTION 4: MEDICAL & SAFETY INFORMATION

Are you able to travel safely without medical supervision during transport?
Yes
No
Are you currently scheduled for SPRAVATO® treatment?
Option 1
No

*(Note: Patients receiving SPRAVATO® must have arranged transportation and cannot drive post-treatment.)

SECTION 5: INSURANCE / PAYMENT (IF APPLICABLE)

Will transportation be billed through insurance (if eligible)?
Yes
No

SECTION 6: CONSENT & ACKNOWLEDGMENT

I confirm that the information provided is accurate. I understand this is a non-emergency transportation service and is not a substitute for emergency medical care.

I acknowledge that:

* Transportation must be scheduled in advance

* Delays may occur due to traffic or scheduling

* I am responsible for being ready at pickup time

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FOR OFFICE USE ONLY

Transportation Scheduled
Yes
No
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