Please let us know which region you are in, local providers will receive a copy of your request. —Please choose an option—East of EnglandEast MidlandsLondonNorth EastNorth WestScotlandSouth EastSouth WestWalesWest MidlandsYorkshire and the Humber
Your name*
Your email address*
Your phone number*
Pickup postcode*
Destination postcode*
Do you require a wheelchair?* —Please choose an option—YesNo
Do you require a stretcher?* —Please choose an option—YesNo
Do you require oxygen?* —Please choose an option—YesNo
Are you on a drip?* —Please choose an option—YesNo
Do you require assistance to walk?* —Please choose an option—YesNo
Please give us all relevant details (eg dates, special requirements not stated above etc)*
When you submit your details through this form your request will be sent to ambulance service providers in your region. One of these providers will then contact you by phone or email to discuss your request. IAA accepts no responsibility for the subsequent contract which may then be formed between you and the provider.
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