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If you are signing up for yourself, please fill out the GRAY form. If you are signing up your child(dren) fill out the GREEN form.

Columbus Children's Signup Form

PARENT / SELF INFORMATION

Address
Organization Referred By:
PCS Columbus

CHILD / CHILDREN'S INFORMATION

What type of insurance does your child have?
Gender ( Child 1)
How would you like your child to receive services (1)?
Virtual
In- Person
What type of insurance do you have (2)?
Gender(2)
How would you like your child to receive services (2)?
Virtual
In- Person
What type of insurance do you have (3)?
(3)Gender
(3)How would you like your child to receive services?
Virtual
In- Person

Columbus Signup Form

ADULT SIGNUP INFORMATION

Gender
Birthday
Month
Day
Year
Address
Type of service I am looking for
What type of insurance do you have?
How would you like to receive services?
Virtual
In- Person
Organization Referred By:
PCS Columbus
Working from Home

Cincinnati Signup Form

ADULT SIGNUP INFORMATION

Gender
Birthday
Month
Day
Year
Address
Type of service I am looking for
What type of insurance do you have?
How would you like to receive services?
Virtual
In- Person
Organization Referred By:
PCS Cincinnati
I Dream Academy
Catalyst
Kampusland
Love In Action

*IF SIGNING UP FOR PERSONAL SERVICES FILL OUT PURPLE FORM. IF SIGNING UP A CHILD, FILL OUT GOLD FORM 

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Sign Up For Services Below

Sign Up For Services Below

Our transportation service is FREE to Medicaid beneficiaries.

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Health Services and Pharmacy rides to and from Destinations for, but Not Limited to the Following:

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. Case Management Visits
. Chemotherapy
. Counseling Services
. Dialysis
. Diagnostic Assessments 
. Doctor visits
. Hospital Discharge
. Medication Management 
. Mental Health Services
. Pharmacy Prescription Pick-ups
. Physical Therapy 
. Rehabilitation & Recovery
. Substance Abuse Services
. Therapy Sessions
. Transferring of Hospital Facilities

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FREE Non-Emergency Medical Transportation through Primary Care Solutions is an important service for individuals needing assistance getting to and from health-related appointments and pharmaceutical pick-ups. Medicaid beneficiaries provide NO out of pocket costs for any of the transportation services rendered.

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Primary Care Solutions NEMT is a great choice when you really need someone to take you to appointments when the need is not immediately life threatening. The next time that you need to take a trip, consider non-emergency medical  transportation. 

 

You can make this call directly or have your caseworker, caregiver, doctor’s office, therapist, a friend or relative call the number listed and ask to be transported by Primary Care Solutions. It’s that simple. Just be ready and on time for pickup for a safe, professional and efficient transport to and from your destination. 

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