Register as a rider

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Not sure why we need this information? Feel free to contact us at dhollis@diligenttransportation.org of 1-478-662-8285

Email *

I am... *

registering because I am ready to book a trip

registering in anticipation of using the service in the future

Rider's First and Last Name *

When is the appointment or event that you will be needing transportation for? Provide details such as location and time. (Please call 478-662-8285 to follow up on the accommodations.)

How where you referred to Diligent Transportation Services Corporation

Do you require wheelchair accessible transportation? *Why are we asking about wheelchair width? One of our accessible vehicles is only able to accommodate wheelchairs smaller than 30.5".

I use a wheelchair that is LESS than 30.5" across at its widest point, and require transportation in an accessible vehicle

I use a wheelchair that is MORE than 30.5" across at its widest point, and require transportation in an accessible vehicle

I use a wheelchair but I am unsure of its dimensions; I will provide this information at a later time

I use a folding wheelchair but can transfer to a passenger vehicle

I do not require accessible transportation

Other:

Clear selection

Year of Birth *For statistical purposes, and to determine eligibility for certain automatically applied fare subsidies

Street Address *

Mailing Address*

City

Postal Code

Phone Number

Emergency Contact Information

Emergency Contact Phone Number

Relationship (with emergency contact)

Which requirement do you meet according to your circumstances ?

Are you a senior age 55+

Are you disable(Is so provide documentation)

Are you Veteran

Clear selection

Do you have Medicaid, Medicare, or both?

What is your income level?

1 $21,881

2 $28,614

3 $35,347

4 $42,079

5 $48,812

6 $55,545

7 $56,807

8 $58,069

*For households with more than eight people, add $1,262 per additional person.

Clear selection

Mobility Issues Select all that apply

I use a cane/walker

I cannot get into/out of a vehicle without assistance

I have hearing impairment

I travel with an oxygen tank

Other

Why are you interested in using this service? *

I do not own a vehicle due to economic barriers

I own a vehicle, but have economic barriers that keep me from operating it

I cannot operate a vehicle due to health/mobility barriers

I own a vehicle, but sometimes it is not available when being used by other family members.

Other

Consent for Collections, Use and Discloser of Information In order to accomplish our service, we collect personal information from our riders. This information is not shared by Diligent Transportation Services Inc except for statistical purposes (where personally identifiable information is not included), and is used by our organization to tailor our services to your needs. More information can be found in our privacy policy.Do you consent to the collection, use and disclosure of your information? *

Yes

I am registering for someone else, but they give their consent

I am an DTS dispatcher registering a new rider by phone

I have read (or heard) and understood this information. *

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