Make An Appointment

If you would like to schedule transport with Western Berks EMS please complete the form below to submit the required information to our dispatcher. We will confirm submitted appointments.

"*" indicates required fields

Patient Information

Name of Patient*
Address of Patient*
Please use a number we can call to confirm the appointment.
MM slash DD slash YYYY
Does the Patient have their own wheelchair?*
Are there any steps to the residence?*
Can the Patient walk steps?*

Drop-off Location Information

Address of Drop-off Location*
MM slash DD slash YYYY
Will anyone be riding along with the patient?*
Name of Rider

You can also call our dispatchers at 610-678-1545 and press “1” to make any appointments.

When calling to schedule a Wheelchair Transport, please provide the following information:

  • Name of patient
  • Date of birth
  • Social Security #
  • Address
  • Weight
  • Do they have their own wheelchair?
  • Are there any steps to the residence and if so, how many?
  • Can they walk steps?
  • Name and address of drop off location (including Suite #)
  • Doctor’s Name
  • Date of the appointment and time
  • Will anyone be riding along with the patient?