On-Going Dialysis

This online application should only be filled out by a referring social worker from approved dialysis locations. 
Upon receiving and evaluating the application, a DTS staff member will reach out by telephone and / or email advising the social worker of the status of the application. 
The potential consumer of our services should be advised by the social worker of the following:

  • As of 12/31/2013, Gloucester County no longer provides dialysis transportation on holidays or weekends.
  • Gloucester County only transports to a dialysis center closest to the consumers' residence.
  • Once a time slot, days and location is approved, any subsequent changes in the aforementioned criteria of your original application may result in Gloucester County being unable to meet the new requirements due to previous commitments.  In this case, you may be placed on a waiting list until such time availability arises on a route.  You would also be responsible for your own transportation to and from the dialysis unit during this period.
  • Completion of this application does not guarantee approval or utilization of Gloucester County Transportation services.  When services cannot immediately be rendered, the consumer will be placed on a waiting list.  When availability arises for you, we will contact you to verify you still desire transportation.  You are invited to contact us at any time to check your status on the waiting list.

Please call 856-686-8350 with any questions regarding this process .

If you are unable to complete the online application and need to print out the form 
click here -->
Dialysis Treatment Tranportation Request
Mail the completed application to the address listed on the bottom of the form.

Dialysis Transport Request









MaleFemale
MobilityVisionHearingCognitiveMentalOxygen TankService AnimalNone
Fresenius WoodburyKennedy SewellRenal Davita Sewell/MantuaFresenius Swedesboro
MondayTuesdayWednesdayThursdayFridayOne WayRound Trip



YesNo
YesNo
Yes, I have
I have not
YesNo

By pressing the SUBMIT button you understand that this is only an application and does not guarantee transportation services.

A DTS representative should contact you in 3 - 5 business days.

Completion of this application does not guarantee approval or utilization of the service. Normally, there is a waiting list for ongoing Vocational Transport. Our DTS representative that contacts you will explain in more detail.

Thank you for completing the DTS questionnaire.

  Please enter the word above in the space below