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Book a Transfer

Please fill out the form below to request an appointment for a non-urgent patient transfer. We will respond as soon as possible. Your transfer will not be booked until we contact you to confirm.

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BOOK A TRANSFER WITH ALLIANCE

Type of service
Transfer Date and Time
:

Transfer Details:

Return transfer?
Yes
No
Traveling with an escort?
Yes
No
Oxygen required?
Yes
No
Weight over 250lbs?
Yes
No
Insurance coverage?
Yes
No
Type of Payment

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