IRA Ride Assistance Request

Injury Recovery Aid provides free transportation for Texans recovering from injuries. If you need a ride to a medical, legal, or therapy appointment, please fill out this short form. We’ll review your request and contact you to confirm details. Please reach out to [email protected] with any questions.

Client First Name

Client Last Name

Client Phone *

Client Email *

Address

Pick Up Address

City

State

Postal code

Law Firm Name

Law Firm Website

Type of Appointment

Medical

Legal

Therapy

Other

Date ride is needed

Do you need recurring rides?

Yes

No

Not regularly

Do you use a wheelchair or mobility device?

Yes

No

Sometimes

How did you hear about IRA

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others.

I Understand that this ride service is based on availability and not guaranteed.

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Request A Ride