ORION EMS Ambulance Request Form

Please Note: In a life threatening emergency you should always dial 911 for your local Police, Fire or Ambulance services.


In addition to calling our 24-hour dispatch center at 713-864-7900, you may also request and schedule a non-emergency ambulance transport by filling out the form below.

After receiving the ambulance request form below an operator from Orion EMS dispatch may contact you for additional information, regarding social security number and type of insurance plan or payment options. Please see our FAQ page for help with any additional questions you may have.


Requestor’s Name *
Requestor’s Name
Requestor’s Phone Number *
Requestor’s Phone Number
Location | Date | Time
Pickup Address
Pickup Address
Date Ambulance is Needed
Date Ambulance is Needed
Destination Address
Destination Address
Patient Information
Patient’s Name
Patient’s Name
Patient Gender
Patient’s Physician’s Name
Patient’s Physician’s Name
Patient’s Physician’s Phone
Patient’s Physician’s Phone