Emergency Transportation Request Form


 All Severe Weather Critical Staff should contact their supervisor for transportation assistance.



*First name: *Last name:
*County of Residence:      
*Title: *Unit:
 *Do you provide clinical care?  


*Contact phone number:
Please include the area code.
*E-mail Address: 
*Manager or Designee:
*Manager or Designee phone number:
*Manager or Designee e-mail address:
*Date/time scheduled to work: 

Please include zip code. The command center will be using MapQuest to find your residence. 
Request Form Submitted By:    
(if other than name submitted)
To get a ride home, report to the Incident Command Center:
Cancer Center, 2nd floor (elevators closest to Ardmore Tower).






Quick Reference

Important Numbers

Main 336-716-2011
Patient Info 336-713-0000
Media 336-716-4587
Jobs 336-716-4717

Ways to Give
USNWR 2015-2016Magnet Hospital RecognitionConsumer Choice2015 Best DoctorsJoint Commission Report

Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.