Forest Road

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Ride the Road to Recovery Transportation Request Form

Our mission is to provide secure, safe and timely transportation needs to Surry County residents who require assistance in meeting and exceeding a healthier future.

 

After submitting this form and upon staff review a email or text message will be sent to you confirming your request.

If you have questions please contact Deborah Giep, Surry County Transportation Coordinator at 336-401-8266 or via email at giepd@co.surry.nc.us

By submitting the form below, the rider agrees to the following policies:

  • No Eating

  • No Weapons

  • No Inappropriate Behavior

  • No Loud Music

  • No Alcohol

  • No Controlled Substances

  • No Smoking

  • No Vaping

  • No Chewing Tobacco/Snuff

  • No Additional Stops

  • Water Bottles are Allowed

  • I Agree Not be Under the Influence of Mind Altering Substances

  • I agree to Comply with all COVID-19 Protocols Including Wearing a Mask

Complete each question completely and fully as indicated on the form. Incomplete applications will not be considered.

Request Your Transportation Here!
 

No transportation days in November 2021- 11th, 24th, 25th, 26th

 

No transportation days in December 2021- 23rd, 24th, 27th, 31st

Enter Your Contact Information

Enter Your Address (Pick Up Address)

Details About Your Request

Is This a Reocurring Appointment?
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Is this a One Way or Round Trip?
If Reoccuring, Choose the Days You Need Transporation
Transportation Destination

Other Information We Need to Know

Terms and Conditions

Reminder!!! If you Chose Reoccurring Appointments please make sure to indicate the days you will need transportation assistance. 

After submitting this form and upon staff review a email or text message will be sent to you confirming your request.  Your transportation request is not scheduled until you receive official confirmation from Ride to Recovery Staff.

Our staff strives to meet and exceed appointment requests, please do your part to be ready 10 minutes prior to scheduled arrival times.  We also take pride in a clean, safe environment for your comfort, we request that only water bottles are allowed during travel to and from destinations.  

IMPORTANT:  After submitting your request, a email receipt should be received within ten minutes from a no-reply email address.  Please check your email account and/or spam folder for this email.  If you do not see a receipt email your submission was not received.  Call our office at 336-401-8266 for assistance.