Request for Transportation to Medical Appointments

Please complete this form at least 2-3 business days before you need transportation. Once completed, someone will email you back with a code to set up transportation. By completing this form, you agree that you are using transportation for a non-emergency medical appointment (physical health, mental health) or a Title IX related matter. For more urgent requests, please call Campus Safety to be connected with the Residential Life on call team. For emergencies, please contact Campus Safety at 410-337-6111 for assistance.

If you see this don't fill out this input box.

Last Name *

First Name *

Student ID *

Goucher email address *

Cell phone number *

Reason for appointment

Mental Health

Physical Health

Title IX

Gender-Affirming Care

Appointment date and time *

Note: Transportation assistance can be provided up to two times per month. Please include the dates and times of recurring appointments.

Pick up address *

Desired pick up timePlease provide a time you would like the driver to arrive at the pick up address.

Appointment address *

By submitting this form, you agree to all of the terms and conditions of the medical transportation policy.