Medical Booking Template Person RequestingThis section tells us who is requesting transportation on behalf of your patient or organization. This would be the person we can reach out to with additional questions.First NameLast NameContact PhoneExtension or DepartmentEmailRequest Type– Select –This is a QUOTE REQUESTBook This Trip Now, a quote is not necessaryItinerary Legs You may book up to 6 legs (sets of Pick ups & Destinations) per request. An example of a booking with multiple legs would be as follows: Leg 1 = Pick up passenger at airport and transfer to hotel Leg 2 = Pick up passenger at hotel and transfer to surgery center Leg 3 = Pick up passenger at surgery center and transfer to recovery center, hotel or private residence. Leg 4 = Pick up passenger at recovery center and transfer to airport. How many Legs to this itenerary– Select –123456PreviousNextPassenger DetailsFirst NameLast NameMobile PhoneEmailPreviousNextPickup Date & TimeAppointment Date & TimeNumber of passengersNumber of Large BagsAirport Pickup? Yes NoWhich Airport?– Select –Love Field (DAL)Dallas/Ft Worth International (DFW)Private FBO (ie.. Signature, Atlantic Aviation, etcOrigin AirportAirlineFlight NumberPick Up AddressFBO AddressTail NumberPick up InstructionsDestinationDestination InstructionsPreviousNextLeg 2 Date / Time PassengersLarge BagsPickup AddressPick up InstructionsDestinationDestination InstructionsLeg 3 Date / Time PassengersLarge BagsPickup AddressPick up InstructionsDestinationDestination InstructionsLeg 4 Date / Time PassengersLarge BagsPickup AddressPick up InstructionsDestinationDestination InstructionsLeg 5 Date / Time PassengersLarge BagsPickup AddressPick up InstructionsDestinationDestination InstructionsLeg 6 Date / Time PassengersLarge BagsPickup AddressPick up InstructionsDestinationDestination InstructionsPreviousNextReview: You would like a quote for us to pick up on for a trip that has Legs. Click SUBMIT below to continue or Previous to make changes. Previous Submit
