Request Behavioral Health Transportation | DHA Secured Transportation

Request Transportation

Submit a transportation request or contact DHA directly to coordinate behavioral-health secure transit.

Notice: Please do not include unnecessary medical records, detailed clinical diagnoses, Social Security numbers, or other highly sensitive private health information in this web form.

1. Requester Information

Organization / Facility Name *

Requesting Person Name *

Job Title / Role

Phone Number *

Email Address *

2. Transportation Details

Pickup Location *

Destination Facility *

Requested Date *

Requested Time *

Transport Type *

3. Individual Information

Age Group *

Current Location Type *

Relevant Transportation Notes

Emergency Medical Disclaimer: If the individual is experiencing an immediate medical emergency requiring active medical monitoring, please call 911.