Medical Escort Booking Form

At Selectacare, we are committed to supporting your health and independence with our reliable medical escort services. To help us serve you best, please complete the Medical Escort Request Form below. All fields marked with an asterisk (*) are required to process your request.

Our medical escort services include professional accompaniment to and from medical appointments, assistance with check-ins, mobility support, and communication with healthcare providers if needed. Whether you need a one-time escort or ongoing support, we’re here to make your healthcare experience as smooth and stress-free as possible.

Please share any relevant medical conditions, mobility concerns, or special instructions so we can ensure your safety and comfort throughout the trip. If you require additional support, such as help with prescriptions or note-taking during your visit, just let us know—these services can be arranged for an additional fee.

Accurate information about your appointment details, health conditions, and any accessibility needs will help us provide the highest level of care. Once you’ve completed the form, simply hit submit, and a member of our team will follow up to confirm your booking.

Thank you for choosing Selectacare, where compassionate care meets professional expertise!

Please complete the form below and press submit.