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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*
Your Email*
How did you hear about us?*
Who referred you?
Pick-up Location
Pick-Up City*
Pick-up State/Province*
Drop-off Location
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*
MM slash DD slash YYYY
Primary Insured Name*
Insurance Policy Number*
Insurance Group Number*
Insurance Company Phone*
Comments
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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.

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
This field is hidden when viewing the form
Does patient have insurance?
- Yes
- No
Select Your Insurance Provider*
Your insurance is in-network. A member of our team will reach out to you with more details.
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*
Phone
This field is for validation purposes and should be left unchanged.

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please call us at:
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Our Services
About REVA
For Patients & Families
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Request a Quote

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