Let's get you
on the schedule.

Facilities & Case Managers

Standing order
request form.

Setting up recurring trips for a patient — dialysis, therapy, a weekly appointment? Send us one form instead of calling for every ride. A single page captures the schedule, the insurance and the level of service.

• One page, five sections. Patient and insurance, the standing-order schedule, pickup and drop-off, service type, and who is requesting it.
• Fill it on screen or by hand. Every field is typeable in any PDF reader, or print it and complete it with a pen.
• Return it by email to info@universalhealthcarelogistics.com, with the insurance ID card attached when you have it.
• Booking a single ride instead? Call (305) 564-2941 or use the options above — this form is for recurring schedules.