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Free Medical Repatraition Quote

Complete REVA’s quick and easy request form and get your air ambulance or medical escort quote, or call 1-954-730-9300.

REVA Accepts most major insurance. In-network insurances include BlueCross BlueShield of Florida, Alacura, Humana, Medicare, and Florida Medicaid.

While REVA coordinates ground ambulance transportation for patients using their services, REVA does not provide local ground ambulance transportation to and from appointments.

Financing available for Florida residents.

Your Name*
Your Phone*
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Who referred you?
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Pick-Up City*
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Drop-off City*
Drop-off State/Province*
Patient Age
Please enter a number from 0 to 150.
Type of Transport?*
- Air Ambulance
- Medical Escort *
*Stable patient for commercial transport required
Does patient have insurance?
- Yes
- No
Patient Insurance Company Name
Please note the reason for transport*
Patient Name*
Patient Date of Birth*
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Primary Insured Name*
Insurance Policy Number*
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Insurance Company Phone*
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Free Air Ambulance Quote

Complete REVA’s quick and easy request form and get your air ambulance or medical escort quote, or call 1-954-730-9300.

REVA Accepts most major insurance. In-network insurances include Florida Blue, Humana, Medicare, United Health Care, as well as limited Medicaid products in Virginia, Florida, & Pennsylvania

While REVA coordinates ground ambulance transportation for patients using their services, REVA does not provide local ground ambulance transportation to and from appointments.

Financing available for Florida residents.

Your Name*
Your Phone*
Your Email*
How did you hear about us?
Who referred you?
Pick-up locations
Pick-Up City*
Pick-Up State/Province*
Drop-off Location
City*
Drop-Off State/Province*
Patient Age
Please enter a number from 0 to 150.
Type of Transport?*
- Air Ambulance
- Medical Escort *
*Stable patient for commercial transport required
Does patient have insurance?
- Yes
- No
Patient Insurance Company Name
Please note the reason for transport*
Patient Name*
Patient Date of Birth*
MM slash DD slash YYYY
Primary Insured Name*
Insurance Policy Number*
Insurance Group Number*
Insurance Company Phone*
Email
This field is for validation purposes and should be left unchanged.

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Certificate #Q6JA227M

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