McLaren Health Plan
Non-Emergency Transportation Request

Non-Emergency Transportation Request

Note: Fields marked with an * indicates required field

If you have not completed a transportation survey within the past year you must contact Customer Service at 888-327-0671 before you can use this form.

To use this form you MUST submit 24 hours or more before your appointment for appointments within 30 miles of your home and 48 hours or more for appointments over 30 miles from your home. For transportation over 30 miles from your home, a letter of medical necessity may be required. Urgent same day requests must be requested by calling Customer Service at 888-327-0671 (TTY:711).

As a reminder McLaren Health Plan only covers transportation for services covered by MHP.

All Fields Must Be Completed