Travel Request

You must book your medical appointment before submitting a request.
Appointment booked?  *
Who is making this Travel Request? * required fields
Do we contact you or the Client for more information?
Your first name  *
Your last name  *
Your phone number  *
City  *
Province  *
Your email address
Verify E-mail address
Your relationship with the Client (person who needs to travel)
Information about who needs our assistance
Salutation  *
First Name (As appears on ID)  *
Last Name (As appears on ID)  *
Date of Birth (MM/DD/YYYY)  *
Home telephone number  *
Cell phone number
E-mail address
Verify E-mail address
Current Address  
  Street Address  *
  City  *
  Province  *
  Postal Code  *
What is your Language Preference?  *
Next Page

Hours of Operation
Monday – Friday: 9:00am – 7:30pm EST
Saturday & Sunday: CLOSED

Your Privacy is important to us!

At Hope Air we recognize the importance of privacy and are committed to maintaining the accuracy, confidentiality and security of all personal information we are given.
This privacy policy describes the personal information that Hope Air collects, how we manage the information and the circumstances under which we may disclose that information. For more information, see our full
Privacy Policy