Close

Our Satisfaction Guarateed Policy

If CVS Transportation Services is the cause of the client being late to an appointment, or experiencing longer than expected wait time, there will be no charge for that trip.
Satisfaction Guarantee Policy
Transportation Request Form

Please call if request is submitted less than 24 hours from the pick-up time. Our system will automatically send a confimation email. If you do not receive this email within 5 Minutes, please give us a call at (248) 352-8380 to confirm.


Please enter information for client here

Client Name:

Invalid Input
City:

Invalid Input
Phone:

Invalid Input

Who is requesting our service?

Requested By: (*)

Name Required
Fax:

Invalid Input

Please enter Case Manager information here

Company:

Invalid Input
Address:

Invalid Input
State:

Invalid Input
Phone:

Invalid Input
E-Mail:

Invalid Input

Please enter Insurance Information here

Company:

Invalid Input
Address:

Invalid Input
State:

Invalid Input
Phone:

Invalid Input
E-Mail:

Invalid Input

Please enter Adjuster Information here

Company:

Invalid Input
Address:

Invalid Input
State:

Invalid Input
Phone:

Invalid Input
E-Mail:

Invalid Input

Please enter Attorney Information here

Company / Firm:

Invalid Input
Address:

Invalid Input
State:

Invalid Input
Phone:

Invalid Input
E-Mail:

Invalid Input

Pick Up Information

Date Service was Authorized? (*)

You must provide date of authorization!
Appointment Date:

Invalid Input
Appointment Time: (*)

Invalid Input
Travel Days:








Invalid Input
Client Needs:

Invalid Input
Pick Up Location:

Invalid Input Please include Street Address, City, State, and Zip Code
Destination:

Invalid Input
Special Request:

Invalid Input
Comments:

Invalid Input




Download a PDF Form to save to your computer.




Address:

Invalid Input
State:

Invalid Input






Phone: (*)

Phone number is required!
E-Mail: (*)

Invalid E-Mail Address!



Manager:

Invalid Input
City:

Invalid Input
Zip Code:

Invalid Input
Fax:

Invalid Input






Agent:

Invalid Input
City:

Invalid Input
Zip Code:

Invalid Input
Fax:

Invalid Input
Claim Number:

Invalid Input



Adjuster:

Invalid Input
City:

Invalid Input
Zip Code:

Invalid Input
Fax:

Invalid Input






Attorney:

Invalid Input
City:

Invalid Input
Zip Code:

Invalid Input
Fax:

Invalid Input












AM or PM?

Invalid Input