Private Transfers

• You can book our services to transfer you or your loved one, to get where you need to go in the safety and comfort of a fully equipped ambulance.
  ambulance transfers usually the safest way for patients who are bed-bound or who have complex needs, to get to their destination.
• Book our services to get you to;

• Interhospital transfers
• Relocation to a new area.
• your next appointment, if you require support during the appointment this can also be arranaged.
• Speciality transfers for end of life and palliative patients, rates are heavily discounted to help support you or your family's wishes.

Request Transfer

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Form Completed by: (contact person)*

Patients Name: (if different from above)

NHI #: (hospital transfers)

Contact Number:*

Email:*

Date: (please use datepicker or format DD/MM/YY)*

Pickup Time:* Please choose a time ASAP 01:00 01:15 01:30 01:45 02:00 02:15 02:30 02:45 03:00 03:15 03:30 03:45 04:00 04:15 04:30 04:45 05:00 05:15 05:30 05:45 06:00 06:15 06:30 06:45 07:00 07:15 07:30 07:45 08:00 08:15 08:30 08:45 09:00 09:15 09:30 09:45 10:00 10:15 10:30 10:45 11:00 11:15 11:30 11:45 12:00 12:15 12:30 12:45

AM/PM*

AM
PM

Appointment time:* Please choose a time ASAP 01:00 01:15 01:30 01:45 02:00 02:15 02:30 02:45 03:00 03:15 03:30 03:45 04:00 04:15 04:30 04:45 05:00 05:15 05:30 05:45 06:00 06:15 06:30 06:45 07:00 07:15 07:30 07:45 08:00 08:15 08:30 08:45 09:00 09:15 09:30 09:45 10:00 10:15 10:30 10:45 11:00 11:15 11:30 11:45 12:00 12:15 12:30 12:45

AM/PM*

AM
PM

Pickup Address:*

Destination Address:*

Patient Special Requirements e.g. patient Nil by mouth, patient poor hearing, patient stroke limited communications, patient palliative care..)

Wheel Chair

Stretcher

RN / Escort with Patient

Oxygen

Infection Caution

Notes:

Thank you - your form was successfully sent. We should be in touch with you within 15 minutes, if not please call Glen on: 027 663 1151. On Call Transfer: 027 663 1152

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