Ride Request Form

Full Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Type of Service

Schedule Your Ride

Terms and Conditions: By submitting this form, you agree to abide by all the terms and conditions set forth by our organization. Please read carefully before proceeding. If you have any questions, contact our support team.

Please read and accept the terms and conditions below.*

Trusted Path Transport LLC / TPT Reliable Care LLC&#13;&#10;Terms & Conditions – Service Responsibilities&#13;&#10;By booking or using transportation services with Trusted Path Transport LLC and/or TPT Reliable Care LLC (“the Company”), the client or booking party acknowledges and agrees to the following terms regarding service responsibilities and limitations.&#13;&#10;&#13;&#10;1. Transportation Service Provided&#13;&#10;Trusted Path Transport LLC and TPT Reliable Care LLC provide non-emergency transportation services for riders traveling to medical appointments, therapy visits, pharmacies, grocery stores, and other non-emergency destinations.&#13;&#10;The Company’s responsibility is limited to providing safe transportation from the pickup location to the requested destination.&#13;&#10;The Company does not provide medical care, supervision, or medical transportation services.&#13;&#10;&#13;&#10;2. What the Company Is Responsible For&#13;&#10;The Company agrees to:&#13;&#10;• Provide transportation using drivers who meet company screening and safety requirements&#13;&#10;• Operate vehicles that meet basic safety standards&#13;&#10;• Transport riders to the scheduled destination in a safe and professional manner&#13;&#10;• Provide basic assistance entering and exiting the vehicle when reasonably possible&#13;&#10;• Maintain respectful and professional conduct toward all riders&#13;&#10;&#13;&#10;3. What the Company Is Not Responsible For&#13;&#10;Trusted Path Transport LLC and TPT Reliable Care LLC are not responsible for:&#13;&#10;• Providing medical care or medical supervision&#13;&#10;• Lifting or physically carrying passengers&#13;&#10;• Monitoring medical conditions during transportation&#13;&#10;• Administering medication&#13;&#10;• Providing wheelchair lifting services unless specifically arranged&#13;&#10;• Assisting inside homes or medical facilities beyond basic entry or exit assistance&#13;&#10;• Escorting clients inside buildings unless previously arranged&#13;&#10;• Supervising riders after drop-off&#13;&#10;Drivers are not caregivers or medical professionals.&#13;&#10;&#13;&#10;4. Rider Responsibilities&#13;&#10;Riders or booking parties are responsible for:&#13;&#10;• Providing accurate pickup and drop-off information&#13;&#10;• Being ready at the scheduled pickup time&#13;&#10;• Informing the Company of mobility needs or medical conditions that may affect transportation&#13;&#10;• Ensuring the rider can safely enter and exit the vehicle with minimal assistance&#13;&#10;• Ensuring the rider is medically stable for transportation&#13;&#10;The Company may refuse service if a situation presents a safety risk to the rider or driver.&#13;&#10;&#13;&#10;5. Mobility and Assistance Limitations&#13;&#10;Drivers may assist riders with basic support, such as offering an arm for stability.&#13;&#10;Drivers are not permitted to physically lift passengers or provide medical assistance.&#13;&#10;If a rider requires lifting, medical supervision, or specialized transportation equipment, alternative transportation services may be required.&#13;&#10;&#13;&#10;6. Delays and Scheduling&#13;&#10;While the Company makes every effort to arrive on time, delays may occur due to circumstances beyond the Company’s control, including:&#13;&#10;• traffic conditions&#13;&#10;• weather conditions&#13;&#10;• road closures&#13;&#10;• prior ride delays&#13;&#10;The Company is not responsible for missed appointments resulting from circumstances outside of its reasonable control.&#13;&#10;&#13;&#10;7. Personal Belongings&#13;&#10;Riders are responsible for their personal belongings.&#13;&#10;Trusted Path Transport LLC and TPT Reliable Care LLC are not responsible for lost, forgotten, or damaged personal items left in vehicles.&#13;&#10;&#13;&#10;8. Vehicle Safety Cameras&#13;&#10;Vehicles used for transportation services may be equipped with interior and exterior cameras for safety and security purposes.&#13;&#10;By using the service, riders acknowledge and consent to this safety monitoring.&#13;&#10;&#13;&#10;9. Limitation of Liability&#13;&#10;To the fullest extent permitted by law, Trusted Path Transport LLC and TPT Reliable Care LLC shall not be held liable for:&#13;&#10;• injuries resulting from pre-existing medical conditions&#13;&#10;• incidents caused by rider actions or behavior&#13;&#10;• delays caused by traffic or weather conditions&#13;&#10;• events beyond the Company’s reasonable control&#13;&#10;&#13;&#10;10. Agreement to Terms&#13;&#10;By booking and paying for transportation services, the client or booking party confirms that they have read, understood, and agreed to these Terms & Conditions.

Appointment Request Form, MD

Terms and Conditions