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. 

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For more information on services available, please see Interior Medical Transport's service page.

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• 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.

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