Book a Ride

Complete the form below to request non-emergency medical transportation. We will review your request and contact you to confirm availability, details, and pricing.

Rider Information

Full Name *

Phone Number *

Email Address

Date of Birth

Veteran Status *

Pickup Details

Pickup Address *

City *

Pickup Date *

Pickup Time *

Appointment Details

Facility Name *

Destination Address *

Appointment Time *

Type of Appointment *

Return Trip

Do you need a return trip?

Yes No

Estimated Return Time (if applicable)

Will rider call when ready?

Yes No

Rider Mobility & Needs Please select any that apply:

Ambulatory Needs assistance Uses walker Uses cane Other mobility aids

Emergency Contact

Emergency Contact Name *

Emergency Contact Phone *

Relationship to Rider

Additional Notes or Special Requests

I understand this is non-emergency medical transportation only. In case of emergency, I will call 911. *

Thank You!

Your ride request has been submitted successfully. We will contact you shortly to confirm availability, details, and pricing.

Error

There was an issue submitting your form. Please try again or call us at (219) 555-0100.

Need Immediate Help?

Phone

(219) 240.9555

info@familyfirst.org

For faster scheduling, call or text us directly. Submitting this form does not guarantee a booking until confirmed by our team.

Family First Foundation

Non-Emergency Medical Transportation

All proceeds support veteran-focused programs through Family First Foundation.

Contact & Service Area

Phone: (219) 240-9555

Email: info@familyfirst.org

Serving: Crown Point • Merrillville • Schererville • Hobart • Saint John • Cedar Lake

Plus surrounding Northwest Indiana

Limited service to Chicagoland

Important Notice: This service provides non-emergency medical transportation only. If you are experiencing a medical emergency, call 911 immediately.

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