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The Ambulance Online Network
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If you are in need of medical transportation, you have found the leading online broker. You will get several options and the most competitive quotes in minutes. SAVE money and SAVE time.

Ambulance-Online.Net is an online broker, we allow you to submit your Medical Transport Request below. Then, all Ambulance-Online.Net qualified and accredited members will compete for your business. Members will respond within an hour with several quotes.

Best of ALL, Ambulance-Online.Net is a FREE service. Ambulance-Online.Net has members that are Insurance Approved providers. Just submit this information and they will coordinate with your Insurance for you.

 

 

“Simply the Best, as a Case Manager, I spend alot of time working with

transportation companies, Ambulance-Online.Net, spends the time working for me and I thank them and all the members."

 

Your the Greatest!

 

Thanks,

S. Watson

Florida

Use the form below to request a quote from leading Medical Transportation Providers.

Requestor Information:

Transport Urgency:

Immediate Future Info Only

Your Name:
Telephone: International please include country code
E-Mail:

How do you prefer to be contacted?:

 By Phone By Email
Relationship to Patient:
Special Request:

Primary Factor:

Price Aircraft Type Number of Patients

Patient Information:
Patient's Name:

Patient's Age:

 Date of Birth: dd/mm/year

Patient's Weight:

 Patient's Height:

Please Describe Patient's Medical Condition:

Is this patient on a ventilator?:

 Yes No

Number of additional persons:

Expected Transport Date:

Service Requested:(You may select more than one.)
Commercial Escort (Worldwide)
Commercial Stretcher (Outside U.S. Only)
Ground Transport (Inside U.S. Only)
Piston Twin (Inside U.S. Only)
Turbo Prop (North America Only)
Jet (Worldwide)
Heavy Jet (Worldwide)
Other (Please Specify):
Transfer To and From:

Transfer FROM:

Name of Hospital / Other:
City:
State / Country:


Transfer TO:

Name of Hospital / Other:
City:
State / Country:


Patient Insurance Information:
Insurance Company Name:
Insurance Company Address:
Insurance Company ID Number:
Member ID:
Group ID:

Be prepared to provide copies of Insurance Cards to Provider

Additional Information:

How did you hear about us?

Please specify Name, Type, or Other:

Please add any additional comments:

Please enter the black letters of the security code into the field. The letters are case sensitive.   
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