Hello and thank you for using our transportation services.

Fill out the form below and submit it. An INDVSA driver will contact you asap to arrange your ride to and from your medical appointment. If you have any questions call our transportation line at 509-723-3440.

 

First Name *

Last Name *

Pickup Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Your Phone *

Email Address

ENTER YOUR DESTINATION ADDRESS BELOW:

Medical Office Name *

Medical Office Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

ENTER YOUR ACTUAL APPOINTMENT DATE AND TIME BELOW:

Appointment Date *

Your Appointment Time *

Hours

Minutes

AMPM

INFORMATION FOR YOUR DRIVER:

Approximate Wait Time *

Hours

Minutes

AMPM

How Long Do You Think Your Appointment or Procedure will be?

Pickup Time *

Hours

Minutes

AMPM

Return Time *

Hours

Minutes

AMPM

Check All That Apply

Do you have a wheelchair?Is the wheelchair specialized, electric or heavy?Do you have mobility challenges?Will you need help getting into our van?Check this option if you have any special considerations and enter them in the box below.

Message or Comments for Your Driver0 / 250

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