Request a Ride

Answer a few questions and a representative will contact you to confirm availability, scheduling, and pricing. You can see our private-pay rates first.

No payment required at this time

We call to confirm every trip

Prefer to call? (407) 357-0678

Secure & confidential

Call first if the rider is over 230 lbs, or the trip involves a building with multiple floors: (407) 357-0678. Weekend trips are by appointment.

Patient Information

First Name *

Last Name *

Date of Birth *

Gender

Height *

Weight (lbs) *

Service Type *

Special Needs (select all that apply)

Stairs to Home Personal Oxygen Needs Wheelchair

Insurance & Payment

Payment Method *

Private pay: you’ll get a secure payment link after we confirm your price. We never ask for card details on this form.

Insurance Carrier

Member / Policy ID

Group Number

Pickup & Drop-off

Pickup Street Address *

Apt / Suite / Unit

City *

State *

ZIP Code *

Pickup Contact Phone

Hospital / Facility Room

ALF / SNF Room Number

Drop-off Street Address *

Apt / Suite / Unit

City *

State *

ZIP Code *

Contact Information

Your Name *

Relationship to Patient *

Email Address *

Phone Number *

Billing Information

Responsible Party *

Responsible Party Phone *

Prior Authorization / Approval Name

Trip Details

Trip Date *

Pickup Time *

Appointment Time

Estimated Return Time

Trip Type *

Round Trip One Way

Additional Passenger *

Yes No

Additional Notes

I understand this request does not guarantee booking. I will receive a confirmation call with pricing before anything is finalised.

How Booking Works

Scheduling non-emergency medical transportation with Leyland Transport is straightforward. Fill out the request form above, and our team handles everything else — no hassle, no surprise charges, no obligation until you confirm.

Submit Your Request

Complete the form with your patient details, pickup and drop-off addresses, and trip date. Takes a few minutes.

We Call to Confirm

A Leyland Transport representative calls you to confirm availability, answer questions, and provide your exact quote. No payment is required at this stage.

Your Driver Arrives On Time

Your background-checked driver arrives at the confirmed time and provides full door-to-door assistance throughout your trip.

Who We Transport

We provide non-emergency medical transportation across Central Florida for a wide range of patients and trip types. Select the service type that matches your needs in the form above.

Ambulatory Transport

For patients who can walk but need assistance getting in and out of vehicles or navigating to their appointment.

Wheelchair Transport

ADA-compliant vehicles with ramps, tie-downs, and restraints. Full door-to-door assistance from home to facility and back.

Call First If…

The rider is over 230 lbs, or pickup or drop-off is in a building with multiple floors. We will confirm the right vehicle and a working elevator. We do not offer stretcher transport. Weekend trips are by appointment.

Insurance & Payment

How payment works today:

Private pay — credit or debit card (available now)
Facility or institutional accounts (call to arrange)
Florida Medicaid and Veterans Affairs transport — in progress, not yet accepted

Questions about payment? Call us before you book.

Common Trip Types

Dialysis — recurring 3x/week schedules
Hospital admissions & discharges
Specialist & follow-up appointments

Coverage Area

We serve 13 counties across Central Florida including:

OrangeOsceolaSeminole LakePolkVolusia BrevardHillsboroughPinellas PascoHernandoCitrus Sumter

View full service area →