Facility Partnership Application

Estimated Monthly Volume *

Service Types Needed *

Ambulatory (Sedan/SUV)Wheelchair (ADA Van)Stretcher (Ambulette)

Trip Types

Do you need same-day transport capability?

Dream Care Rides is a private-pay transportation service. We do not bill Medicare or commercial insurance — insurance-funded trips are handled only through our provider partners. Illinois Medicaid is accepted solely for trips starting within 6.5 miles of our Olympia Fields or Palatine bases. Facility partnerships run on direct facility billing, patient private pay, or a mix of both.

How will trips be paid? *

Facility accountYour facility authorizes trips and we invoice monthly (net-30). No patient payment collection, per-trip itemization.Patient private payPatients book and pay directly with upfront quoted pricing. Your schedulers just hand them our number.MixedThe facility covers certain trip types (discharges, procedure days); patients pay privately for the rest.

Optional (check any that apply)

Some of our patients are covered through an insurance provider partner — contact me about partner eligibilityWe serve Medicaid patients whose trips start within 6.5 miles of your Olympia Fields or Palatine bases

Estimated Monthly Volume *

Service Types Needed *

Ambulatory (Sedan/SUV)Wheelchair (ADA Van)Stretcher (Ambulette)

Trip Types

Do you need same-day transport capability?

How will trips be paid? *

Optional (check any that apply)