Lien Cases and Services | Medical Transportation Company - MedSync

Home
Non Emergency Transports
Wheelchair
Senior
Disabled

734.646.8846

Our Specialty Services, IME, Oxygen Administration and Psychiatric Transportation

Working directly with Case Managers and Clients, MedSync Transportation will customize a pickup and drop off schedule for persons who require Medical Transportation throughout the entire state of Michigan, and neighboring states. Our staff is certified to administer Oxygen to those who need it. We accept transportation requests for IME evaluations, as well as trips to and from Psychiatric hospitals.

Medical Transportation Request

All Case managers who are representing a person in need of Non Emergency Medical Transportation in Michigan please provide us with the below information and we will contact the case manager directly.

Case Manager Contact.

Case Manager Name*
First Last
Relationship*

What is your relationship with the person you are refuring for services
Case Manager Phone*
Case Manager Email*
Client Information
Client First and Last Name
First Last
Date Of Birth
MM slash DD slash YYYY
Client Legal Residential Address
Street Address City State / Province / Region ZIP / Postal Code
Client Phone Number
Client Email
Purpose of Transportation*
Client Pick Up Locations*
Street Address City ZIP Code

Where your client will be picked up initially. Client may opt for a different location upon future scheduled transports.
Client Drop Off Location*
Street Address City ZIP Code

Any additional drop off locations will be worked out direct between MedSync Transportation and the Client
Transportation Frequency*
- Weekly
- Monthly
- One Time
How often will the client be traveling?
Cient Requirements*
- Walker
- Wheelchair
- Motorized Wheelchair
- Crutches
- Uses No Aid
Does the person use any type of aid. Please Check
Does the Client Have Attorney Representation*
- Yes
- No
Law Firm Name*
Name*
First Last
Phone*
Fax Number
Email*
If client does NOT have an attorney, please provide adequate description to why the person is without legal representation*
Payment Type*
- Credit Card
- Check
- Insurance
Please select the preferred method of payment.
Insurance Information
If you selected insurance as payment method, please fill in the below fields.
Insurance Company Name*
Insurance Compnay Main Phone*
Name of Insured Party*
Claim Number*
Date Of Loss*
MM slash DD slash YYYY
Claim Adjusters Name*
Claim Adjusters Phone*
Claim Adjusters Phone Extention*

Navigation

MedSync Transportation and Services: Specialty Assistive Non-Emergency Transportation Service. We Are Always There For You!

- Senior Transportation

- Assistive Transportation

- Wheelchair Transportation

- Non-Emergency Transportation

- Contact

Our Specialty Services, IME, Oxygen Administration and Psychiatric Transportation

Medical Transportation Request

Case Manager Contact.

Client Information

Insurance Information