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October 3rd, 2023 |

Get a Quote – Private Charter

athomasOctober 3, 2023

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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. Humana in network.

Financing available for Florida residents.

call 1-877-861-7382

Your Name*
Your Phone*
Your Email*
How did you hear about us?
Who referred you?
Pick-up Location*
Drop-off Location*
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
Is there a physician referral / doctor’s order for transport?
- Yes
- No
Patient Insurance Company Name
What else would you like to tell us?
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.

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. Humana in network.

Financing available for Florida residents.

Your Name*
Your Phone*
Your Email*
How did you hear about us?
Who referred you?
Pick-up Location*
Drop-off Location*
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
Is there a physician referral / doctor’s order for transport?
- Yes
- No
Patient Insurance Company Name
What else would you like to tell us?
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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