Scheduling Form Testing
  • Insurance Provider
  • Confirm & Submit

Insurance Provider

Who is your insurance company?
Tennessee Carriers only books rides for UnitedHealthcare and Wellpoint members.

Member Information

Member Verification

Please supply one of the following

Trip Details

Rides must be scheduled 72 hours before appointment.
What time is the appointment?

Pickup Details

For example, home or doctor’s office, etc.
What is the address of the pickup location?
What is the address of the <strong>pickup</strong> location?
City
State/Province
Zip/Postal

Drop-off Details

Address not listed
For example, home or doctor’s office, etc.
What is the address of the drop-off location?
What is the address of the <strong>drop-off</strong> location?
City
State/Province
Zip/Postal

Additional Questions

Are there any additional riders?
What is the address for the additional stop?
What is the address for the <strong>additional stop</strong>?
City
State/Province
Zip/Postal
What is the scheduled time for the additional stop?
What time will a return ride be needed to complete the trip?
You must call the Tennessee Carriers call center when you are ready to go home. United HealthCare members should call 1-866-405-0238. Amerigroup members should call 1-866-680-0633.
Do you understand and agree to call Tennessee Carriers when you are ready to be picked up?