Ride Request Form

CS - Transportation - Taxi & Specialty Ride Request

"*" indicates required fields

Important Information for Scheduling Rides

Current Clients with Valid Service Agreements Only: Ride requests can only be scheduled for individuals who are current clients of ConnectAbility of MN and have a valid service agreement in place. If you are unsure about your status, please contact our office for clarification before submitting a ride request.

24 Business Hours Notice Required: All ride requests must be submitted at least 24 business hours in advance. Our business hours are Monday through Friday, 8:00 AM to 4:30 PM. Requests submitted outside of these hours will be processed on the next business day.

We appreciate your understanding and cooperation in helping us provide the best possible service!

Name*

First Last

Phone*

Date of Birth*

This information helps us verify your identity

Pick Up Time Type*

Set Time

Will Call

Date*

Set Time

Time*

Set Time

Date*

Will Call

Pick Up Address*

Street Address City ZIP Code

Drop Off Address*

Street Address City ZIP Code

Will there be a service animal present for this ride?*

Yes

How many passengers will be present for this ride?*

Please enter a number from 1 to 3.

Number of passengers, including yourself

Is a return ride needed?*

Yes

Pick Up Time Type*

for Return Ride

Set Time

Will Call

Return Ride Date*

Set Time

Return Ride Time*

Set Time

Return Ride Date*

Will Call

Drop Off Address*

for Return Ride

Street Address City ZIP Code

Ride Request Form

CS - Transportation - Taxi & Specialty Ride Request

Important Information for Scheduling Rides

Central Office:

South Office:

North Office: