Schedule A Pickup

American Patient Transport Systems, Inc. Patient Pickup form.

Below are just a few of the many locations we serve.

Schedule Online!

Please fill out all of the required fields below.
If you have any questions, please see our contact information below.

Schedule Online!

Please fill out all of the required fields below.
If you have any questions, please see our contact information below.

APTS Schedule a Patient Pickup

Address:
119 East Holly Street, P.O. Box 652
Hazleton, PA 18201

Business Office:
 570-453-1445
 570-459-0626
 
8a-4p M-F
Closed S-S
 
24/7/365

Address:
119 East Holly Street, P.O. Box 652
Hazleton, PA 18201

Business Office:
 570-453-1445
 570-459-0626

 
8a-4p M-F
Closed S-S

 
24/7/365

APTS Schedule a Pickup

Schedule a Pickup

Pickup Date*

Appointment Time*

Transport Type*

Oxygen*

Amount

Patient Name*

Phone*

Pickup Street Address*

City*

Zipcode*

Weight*

Steps*

How Many?

Destination*

Destination Street Address*

City*

Zipcode*

Will an aide accompany the patient?*

Will family meet us at the destination?*

Name of person submitting this form*

Facility Name

Contact Phone Number

Your Email*

Additional Comments
(Special requests will be reviewed & may not be able to be accommodated.)

Schedule a Pickup

Pickup Date*

Appointment Time*

Transport Type*

Oxygen*

Amount

Patient Name*

Phone*

Pickup Street Address*

City*

Zipcode*

Weight*

Steps*

How Many?

Destination*

Destination Street Address*

City*

Zipcode*

Will an aide accompany the patient?*

Will family meet us at the destination?*

Name of person submitting this form*

Facility Name

Contact Phone Number

Your Email*

Additional Comments
(Special requests will be reviewed & may not be able to be accommodated.)

Please dial 911

If you are experiencing an emergency.

APTS

119 East Holly Street
Hazleton, PA 18201
570-453-1445