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630-668-9999
info@specialneedschicago.org

Transportation is available throughout the Chicago metropolitan area, which includes Cook, DuPage, Kane, Will, Lake, McHenry, DeKalb, Kendall and Grundy Counties in Illinois, and Lake County in Indiana.

Long distance trips can be coordinated upon request.

New Customers | Current Customers | Price Information | Contact Us

NEW CUSTOMERS

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NEW CORPORATE CLIENTS

Service for organizations paying for transportation services for their clients are invoiced on a monthly basis.

For high volume services, shuttles, group outings, day programs and standing orders, we will create a customized rate and reservation program for you.
Please contact us directly at info@specialneedschicago.org or

(630) 668-9999 for information.

CLICK HERE for NEW Corporate Client Authorization

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NEW PRIVATE PAY PASSENGERS

Out-of-pocket (self-pay) transportation services are billed to a credit card.

We have no application process, no waiting period, and no medical authorization is needed.

CLICK HERE for NEW Private Pay Passenger Authorization

The above authorization is for NEW corporate and private pay clients.

Once you have submitted your authorization, please proceed to CURRENT CUSTOMERS and place your RESERVATION REQUEST.

CURRENT CUSTOMERS

You are a current customer if you have previously submitted your authorization form.

For corporate clients, this means we already have an account established with your signature on file to accept monthly invoicing.

For private pay individuals, this means we already have an account established with your signature on file and credit card information for billing.

* RESERVATION REQUEST *

To complete your reservation request, either fill out the online form below OR download the form and

return via email to info@specialneedschicago.org or fax to (630) 839-6000

CLICK HERE to download Corporate Client form

CLICK HERE to download Private Pay form

* Required

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* Indicate whether a Private Pay Individual or a Corporate Client:

Corporate Client Corporate Client

Private Pay Individual Private Pay Individual

**Corporate Clients: name of organization -OR- Private Pay: name of passenger

*Transportation Day of the Week

*Transportation Calendar Date

For standing orders, indicate days of the week, start date & end date

*Passenger First Name

*Passenger Last Name

*Primary Phone Number

*Contact Name & Relation to Passenger for Primary Phone Number

*Secondary Phone Number

*Contact Name & Relation to Passenger for Secondary Phone Number

Pickup Facility Name

*Pickup Address

*Pickup City

*Pickup State

Destination Facility Name

*Destination Address

*Destination City

*Destination State

* Mobility Status

Manual wheelchair user Manual wheelchair user
Power wheelchair user Power wheelchair user
Scooter user Scooter user
Ambulatory (able to walk) Ambulatory (able to walk)

* Wheelchair / Scooter Width

(measured to the outside of the rear wheels)

less than 30" wide (most standard chairs average 25") less than 30” wide (most standard chairs average 25”)

more than 30" wide more than 30” wide
N/A N/A

*If Wheelchair / Scooter is more than 30” wide, what is the exact width (indicate width or N/A)

* Total Weight of passenger + wheelchair / scooter

Less_Than_350_lbs Less Than 350 lbs

More_Than_350_lbs More Than 350 lbs

*If total weight is more than 350 lbs, what is the exact total (indicate weight or N/A)

* Do you need a wheelchair rental?

(NOTE: that only standard size chairs are available, rental fee $30)

Yes Yes

No No

*For Doctor Appointments, indicate doctor’s name and/or department plus suite #

*For Doctor Appointments, indicate phone #

For Airport Pickups indicate airline, flight # and arrival time

*Requested Pickup Time (indicate AM or PM). NOTE: actual time may vary

*Appointment Time (indicate AM or PM) time you want to arrive at your destination.

(NOTE: appointment time = time you want to arrive at your destination.)

* Is this a One-Way Ride or Roundtrip
One-way One-way
Roundtrip Roundtrip

* Indicate return trip designation:

Please check... Will-Call (call when done with appointment and we'll send the first available driver)

Estimated Will-Call return time (INDICATE TIME)

Please check... Exact (specific return time, based on availability)

INDICATE TIME

Please check... Wait (driver waits onsite @ $60/hr billed in 15 min increments, based on availability)

INDICATE ESTIMATED DURATION

Please check... NO Return

* Number of Escorts Traveling with Passenger

Please check... 0

1 1

2 2

3 3

more than 3 escorts is a group ride, please contact our office for group pricing

Escort name & phone

*Name of person submitting this reservation

*Title / relation of person submitting this reservation

*Phone number of person submitting this reservation

*Email of person submitting this reservation

Notes

REMINDER: In order to submit a reservation, you must have a signed authorization on file.

* By submitting this form, you agree to our Terms and Conditions

Yes, I agree Yes, I agree

PRICE INFORMATION

Our current fees for standard one-way or roundtrip transportation are as follows:

Mileage is determined from the first point-to-point address response on Google Maps at the time your reservation is placed.
$69.00 each way + $4.00 per mile.
$30.00 each way additional fee for trips from 6:00pm to 6:00am.
$30.00 each way additional fee for trips on Saturdays.
$50.00 each way additional fee for trips on Sundays.

Additional passengers are $6.00 each way, with a maximum of 3 additional passengers. (Over 4 total people is then a group ride, price to be determined on a case-by-case basis.)
Wait fee is $60.00 per hour, billed in 15 minute increments.
$20.00 airport additional fee.
$30.00 wheelchair rental (must be booked at the time of the reservation).
$30.00 additional fee each way for wheelchairs/scooters wider than 30” and/or weight in excess of 350 lbs of passenger + chair. (Oversize / higher weight must be noted at time of reservation.)
TBD price structure for group rides, shuttle service, and trips outside the Chicago metropolitan area.
$75.00 each way additional fee on Holidays. (New Year's Day, Easter, Mother’s Day, Memorial Day, Father's Day, Independence Day, Labor Day, Thanksgiving, Christmas Eve, Christmas Day, New Year's Eve.)
$100.00 each way additional fee for COVID+ passengers.
Gratuity is not included.

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Customer Reviews

Samantha K.

Belmont Village

“You are so great to work with and your drivers are wonderful. I am aware that you are under no obligation to us when we call on short notice, but I am never afraid to ask because you are our best option, and I thank you for being so wonderful to my residents.”

Mark G.

Brother of Passenger

“This is a letter to compliment the driver who transported my sister to the wake and services for the funeral of her husband. The driver somehow convinced my sister to attend the services after she said she would not. He went to the nurses and requested that she be dressed while he patiently waited in the lobby for her. I cannot praise him enough for all he did during the day. He was courteous, compassionate, and calm with her. It is not often that you encounter people like him. If I know of anyone who is in need of such a service I would highly recommend your company.”