Non-Emergency Transportation

The Non Emergency Transportation (NET) program is designed to increase access to medical or counseling appointments for Medicaid eligible individuals.
If you are not familiar with NET, please review the Non Emergency Transportation Plan

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Could I be eligible?

  • You must be a resident of Fairfield County
  • A current recipient of Medicaid

How do I request or cancel transportation?

To request transportation:

  • Online by completing and submitting the form below, or
  • Print a Transportation Request Form  by clicking Here and return via:
      • Fax: Fax your transportation request form to (740) 689-4848
      • Deliver in Person: Transportation requests can be submitted in person at Fairfield County Job and Family Services at 239 West Main Street, Lancaster, OH 43130
      • MAIL: Transportation requests can also be mailed to the address above, or
  • Call the FCJFS Transportation Team at (740) 652-7682, or toll free at 1-800-450-8845

To cancel transportation:

  • Call the FCJFS Transportation Team at (740) 652-7682, or toll free at 1-800-450-8845

Additional Information?

  • You must submit your request at least five business days before your medical appointment.
  • Transportation customers must sign a Rights and Responsibilities form.
  • The Rights and Responsibilities form will be mailed to you upon receipt of your request.
  • If you are on a Managed Care Plan, you can also use their transportation services.

You will be contacted within 24 hours upon receipt of your request to confirm or deny the transportation

Transportation Request

 

FAIRFIELD COUNTY JOB & FAMILY SERVICES

CUSTOMER NET TRANSPORTATION REQUEST

 Patient Name         Social Security# 

 Address 

 Phone  Alternate Phone 

 Appointment Date   Appointment Time 

 Name of Doctor 

 Address of Doctor 

Special Needs
Care GiverCar Seat                    Lift Van                                
OxygenWheelchairOther 

FCJFS will contact you within 24 hours upon receipt of your request to either confirm or deny.

If you have additional appointments, please use this form.



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