Request a Quote

Use this form to request a quote for any of our non-emergency services. If this is an urgent request, please call our dispatch at 208-914-3846.

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Purpose of Quote*
What are you requesting a quote for?
- Transportation (not urgent)
- Event Medical Support

Use this form for non-urgent transportation requests ONLY. We will respond within 24 hours. For urgent requests, please call our dispatcher 208-914-3846. NOTE: For payment purposes you must fax Ins/MA paperwork to 208-375-1196 in order for us to set up your transportation request.
Passenger Name*
First Last
Individual or Company?*
Are you requesting transportation for yourself or on behalf of a company or institution?
- Individual
- Company
Name of Company*
Company Contact Name*
Contact Phone*
Fax Number
Contact Email*
Date Transportation is needed*
Date Format: MM slash DD slash YYYY
Date Transportation is needed
Date Format: MM slash DD slash YYYY
Date Transportation is needed
Date Format: MM slash DD slash YYYY
Event Venue*
Venue Address*
Street Address City State ZIP Code
Billing Address*
Street Address City State ZIP Code
Date of Event*
Date Format: MM slash DD slash YYYY
Date of Event
Date Format: MM slash DD slash YYYY
Date of Event
Date Format: MM slash DD slash YYYY
What Time(s) is the event*
Event Description*
Briefly state what the event is (i.e., a concert, sports event)
Is this event for a charity or a 501(c)(3)?*
- Yes
- No
Name of Charity
Special Requirements or Information we need to know
Round Trip or One Way?*
- Wait for return (round trip)
- One way
Pickup Location Name*
i.e., home, Willow Park Sr. Living, etc.
Pickup Address*
Please enter 9 digit zip (look up here)

Street Address City ZIP Code
Destination Name*
For example, St. Luke's Clinic.
Destination Address*
Please enter 9 digit zip (look up here)

Street Address City ZIP Code
Do you need transportation for a wheelchair?*
- Yes
- No
Do you need gurney transportation?*
- Yes
- No
Medical equipment or supplies required
For example: oxygen, ventilator, cardiac monitor, IV, etc.
How will this trip be paid for?*
- Private pay (cash or check)
- Credit Card
- Commercial Insurance
- Medicare
Date of Birth*
If using medical assistance, please enter the insured's date of birth.
Date Format: MM slash DD slash YYYY
Credit card info*
If paying by credit card, please enter name of the person to call to provide credit card information.
Address*
If paying by cash or check, please enter payee's address.

Street Address City State ZIP Code
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Any further information we need to know?
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Injury Care EMS

Mailing Address:

4850 North Rosepoint Way
Suite 100
Boise, Idaho 83713

208-914-3846 24-7 phone number
1-855-492-9941 Toll Free 24/7
208-939-4411 FAX

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