Your Safety NET - Non-Emergency Medical Care
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Ride-Line - Request a Discharge

Requesting a discharge with Your Safety NET is easy and can be done in a number of different ways. Our Ride-Line (314-660-2428) is our dedicated phone line that allows patients to call in and request their discharge. You can also use the form below to schedule your discharge online, and questions can be directed to the dispatch office via our real-time texting service (314-282-5638).

If requesting a ride other than a discharge, use this form instead.

Facility Contact Information
Name
Address
City
State
Zip Code
Nurse's Name
Nurse's
Station #

Person Being Picked Up
Name
Age
Location (room 321, etc.)
Cell Phone
Email

Destination Address
Name
Address
City
State
Zip Code

Transport Information
Transport
Date		 ,
Discharge
Time
Special Needs
Payment
Method		 Cash   Check
Any Other
Info
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