Nonemergency Medical Transportation Vehicle Permit Application Form
Form Template
Transportation providers can apply to offer non-emergency medical transportation services to eligible patients.
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In order to apply for a transportation provider permit, applicants can fill out and submit the Nonemergency Medical Transportation Vehicle Permit Application Form app. Within the app, the transportation provider requesting a permit can supply the following information: name of service, business address, type of vehicle (wheelchair, stretcher, combo), type of application (new or renewal), vehicle data, and signatures. The applicant must also pay the $60 permit fee to obtain a permit to provide non-emergency medical transportation services to qualifying patients.
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