BACT Community Transport « Transport Request Form

On-line booking requests must be made at least 1 working day* before the date you wish to travel. For bookings of more than 3 passengers or for minibus hire, please call bact 01986 896896. *working days are Mon-Fri 9:30-1630 and do not include Sat, Sun or Bank Holidays. (Therefore if you wish to book Monday transport, transport requests need to be made on the preceding Friday).

Are you a wheelchair user?*

When booking transport for a wheelchair user, it should be noted that for health and safety reasons, we will need to undertake a wheelchair and access assessment in order to ensure that the wheelchair and passenger can be taken in and out of their property safely by our volunteers and the wheelchairs can be secured using fixed anchorage points. In order for this to happen, any wheelchair accessible transport bookings should allow at least a couple of weeks between booking and when a trip is required.

Yes
No

Has Bact already completed a wheelchair assessment or you?*

Yes
No

Name*

First Last

Contact Telephone Number*

We will contact you on this number to confirm your booking. PLEASE INCLUDE AREA CODE

Email*

Date you wish to travel*

Requested pick-up time*

: HH

MM

Do you need to be at your destination for a specific time*

We need to know if you have an appointment time or are connecting to another transport service that runs to a time-table.

yes
no

State appointment time/connecting service time*

: HH

MM

From*

Address line 1 Address line 2 Town/Village

Post code if known

To*

Address/location Town/Village

Post code if known

Do you need a return service from the location you were dropped at*

yes
no

What time do you wish to be collected for your return service*

: HH

MM

Are you travelling alone*

yes
no

Name of additional passenger*

First Last

Are there any more passengers to add*

yes
no

Name of additional passenger*

First Last

Do you have any special requirements*

If "Other" please give detail

Reason for travel*

If "Other" please give detail

If travelling to a hospital please state Department or Area of the hospital.*

Have you paid the annual £16 registration fee?*

From 1st April 2019, bact is introducing an annual registration fee of £16.00, which will apply to all service users with the exception of essential carers.

Yes
No

The Fee will need to be paid before you can travel. Fee can be paid by debit or credit card over the telephone. A member of the Bact booking team will contact you to take this payment.

Thank you for completing your travel request we will contact you on the phone number in this form to confirm if we can assist with your transport requirements.

Please contact Bact on 01986 896896

To arrange for a wheelchair assessment to be completed and to discuss your travel requirements. Office hours are Monday - Friday 09.00-16.00

Transport Request Form

The Fee will need to be paid before you can travel. Fee can be paid by debit or credit card over the telephone. A member of the Bact booking team will contact you to take this payment.

Please contact Bact on 01986 896896

Volunteers’ view