Start Your First Booking

To get a quote for your first ride with Elderwheels, please fill out the form below. This information will help us better understand your unique needs and provide you with the right vehicle and transport specialist.

After your first ride, you can text or call us at 512-850-6335 for bookings.

Start my booking!

Primary Contact First Name

We are trying to get an accurate picture of your needs : )

Last name

Rider information

Name of elder needing transport

Your relationship to elder needing transport

Best email for primary contact and payment invoices/receipts

Phone of Primary Contact

Are you able to receive and answer text messages? (yes/no)

Address (incl zip, apt #)

Phone of Elder

Approx Height, Weight

Age

Logistical information

Select a Transport Service

Date and time of appointment

Month

Day

Year

Time

HoursMinutes

Destination Address (include street, suite #, doctor or medical office name)

Are there steps or a ramp at home (how many, including door threshold)?

Upload a photo of wheelchair, front door access or other pertinent visuals if needed.

This helps us to see the home situation for wheelchair access and estimate the size and type of wheelchair (planning ahead!)

Type of wheelchair

This helps check availability in the correct fleet vehicle (we don't do 2-person stretcher transports)

If walking, please specify (regular walker, 4-wheel walker, cane, uses nothing)

For weights more than 200#, pls specify total width of chair (wheel to wheel)

Give us more details (what is the current situation?)

How did you hear about Elderwheels?

Who should we thank for the referral?