Welcome to Urbana Local Transportation!
Over 32 years of driving experience. Serving Urbana locals since 2021.
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Safety Assessment & Routine Ride Request Form
Mandatory Medical Liability Release Questions for your safety please fill out the form below.
This is a mandatory form that is required for all medical transportation requests to ensure your safety.
Failure to do so will resort in the decline of your ride request.
IF YOU ARE HAVING A MEDICAL EMERGENCY, PLEASE
CALL 911.
Thank you!
At this time, are you experiencing
ANY
of the following symptoms:
* Chest Pain or Pressure
YES
NO
* Difficulty Breathing/Shortness of Breath
YES
NO
* Sudden Weakness/Numbness
YES
NO
* Sudden or Severe Headache
YES
NO
* Confusion or Loss of Consciousness
YES
NO
send
Non-Urgent Ride Request Form
This form is for anyone not having Emergent symptoms >> and <<
for NON-URGENT rides requests with 48 hours advance notice:
* PICK UP DATE
* ONE WAY OR ROUND TRIP?
One Way
Round Trip
* PAYMENT TYPE
Send me a link to pay
Pay in cash in person
CashApp
Chime
PayPal
Venmo
Zelle
* TEXT CONFIRMATION?
Yes send a text
No text
Send