Health Ride Request Form

The Health Ride program through Health & Counseling Services assists Gonzaga University students with transportation to and from healthcare providers.

Please note:

  • This is ONLY for scheduled Health Rides. For urgent evening and weekend health rides, please call the Health Ride Line (509-313-5878).
  • We highly recommend the reservation be made by the end of the business day, the day before the scheduled health ride. If not, we cannot guarantee your reservation and please call the Health & Counseling Services office at 509-313-4052.
  • The Health Ride reservation form is to be completed by Gonzaga University students only.

Please submit the below reservation request for a Health Ride:

(Please do not input confidential or sensitive information on this request form. If you have any questions or concerns, please contact our office at 509-313-4052.)

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* = Required Fields
Contact Information
Return Ride Needed: *
Form of Payment: *

*Please note:

  • If you are wanting to pay with debit/credit, please plan to come into Health & Counseling before your ride to complete your payment.
  • Will you be using a Health Ride punch card for this ride? If so, please plan to come into Health & Counseling before to get your card punched.