Behavioral Health Secure Transportation Service Profile
Please use this form to submit your service's initial profile and to update the profile as needed.

Pursuant to 6 CCR 1011-4, secure transportation services shall complete and submit to the department a service profile that includes: contact information for the service and its owner, manager, or administrator, demographics of the service area, number and types of responding staff, number of calls, counties served, organizational type, and number and type of vehicles.

If your secure transportation service is a licensed ground ambulance agency, please contact the EMTS Branch at 303-691-4932 or cdphe.emtcert@state.co.us.
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Behavioral Health Secure Transportation Service Name *
Behavioral Health Secure Transportation Service Address *
Behavioral Health Secure Transportation Service Phone Number *
Administrator Name *
Administrator Phone Number *
Administrator Email Address *
Describe the demographics of your service area *
Number of calls annually *
Counties served *
Organizational Type *
Number of Type 1 Vehicles (Vehicle with a safety partition that separates the driver from the passenger compartment) *
Number of Type 2 Vehicles (Non-partitioned vehicle) *
Number of Staff Members with Direct Client Contact *
Number of Drivers *
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