Requesting Travel assistance
Please read the information below and answer the preliminary eligibility questions to ensure you are ready to make a travel request. This form allows you to submit a travel request for one patient.
For more information on services available, please see Interior Medical Transport's service page.
IMTS' mandate is to provide assistance for medical transportation for financially limited individuals.
Income information for all household family members for the past 12 months may be required upon request. Household family members with no income should also be listed. Non-family household members and their incomes are not required (i.e. roommates, multi-family homes, other shared households who maintain separate finances).
Please have income sources and totals for all household family members ready before you begin this travel assistance request.
IMTS does random checks to verify patient household income information and may request that you provide documentation of the income figures provided.
Make a Travel Assistance Request
Travel assistance requests should be made as soon as possible to avoid delays. You can complete a travel request form online or email email@example.com