Booking - Young People - SSC Secure Transport

SSC Secure Transport

Young People and looked after children Booking Form

Easily arrange safe, secure, and compassionate patient transport tailored to your needs. Fill out the form below to book our trusted services.

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Bookings are accepted only from hospitals, social services, and other authorised organisations. For all other enquiries, please email [email protected].

I confirm that I am booking on behalf of a hospital, social services, or other authorised organisation.

BOROUGH / COUNCIL DETAILS:

Name of Borough/Council:

Contact Name:

Contact No:

Email:

SOCIAL WORKER DETAILS:

Contact Name:

Contact No:

Email:

EDT WORKER DETAILS:

Contact Name:

Contact No:

Email:

FINANCE DEPARTMENT DETAILS:

Email:

Contact Name:

Can a purchase order be raised as soon as possible and provided to us when available.

DATE TRANSPORT IS REQUIRED:

TIME OF PICK UP:

PICK UP LOCATION:

CONTACT NAME:

CONTACT NUMBER:

DROP OFF LOCATION:

CONTACT NAME:

CONTACT NUMBER:

HAS THIS YP BEEN TRANSPORTED BY SSC SECURE TRANSPORT PREVIOUSLY?

Yes No

FULL NAME OF CHILD / YOUNG PERSON:

DESCRIPTION OF YP:

DATE OF BIRTH:

GENDER:

YP’S PERSONAL ID NUMBER (if applicable):

ANY KNOWN HOBBIES OR INTERESTS:

ANY KNOWN TRIGGERS:

RISK ASSESSMENT / FACTORS

Reason young person is being transported:

Does YP know they are being transported:

Yes No

Medical issues:

Yes No

If yes, please provide details:

Medication:

Yes No

If yes, please provide details:

Allergies:

Yes No

If yes, please provide details:

Drugs misuse / concealment:

Yes No

If yes, please provide details:

Alcohol issues

Yes No

If yes, please provide details:

Possession of Weapons / concealment:

Yes No

If yes, please provide details:

Mental Health or Self Harm:

Yes No

If yes, please provide details:

Previous Suicidal attempts:

Yes No

If yes, please provide details:

DOLS Order?

Yes No

Recovery Order?

Yes No

Interim Care Order / Full Care Order?

Yes No

If yes, please provide details:

Violence – and whether previously directed at professionals:

Yes No

If yes, please provide details:

Known to County Lines, and or Gang Affiliated:

Yes No

If yes, please provide details:

Grooming:

Yes No

If yes, please provide details:

Criminal exploitation:

Yes No

If yes, please provide details:

Child Sexual Exploitation:

Yes No

If yes, please provide details:

Absconder or regularly goes missing:

Yes No

If yes, please provide details:

Previous allegations against professionals:

Yes No

If yes, please provide details:

How did you hear about us?

Google Promotional materials (e.g. flyers, pens, mousepads) Word of mouth / Recommendation Other (please specify)

Other (please specify)

Exclusions Acknowledgement

I confirm that I have read and understood the service exclusions listed above. I acknowledge that:

Stretchers can only hold a maximum of 120 kg.
Palliative patients requiring medical support or patients with complex medical needs requiring nursing care will not be transported unless a RGN is provided by the hospital.
Patients requiring oxygen administration will not be transported.
Only one patient can be transported at a time in each vehicle.
Vehicles cannot accommodate bariatric wheelchairs or mobility scooters.

By ticking this box, I accept these exclusions and understand that transport may not be provided if any of these conditions apply.

SSC Secure Transport

Young People and looked after children Booking Form

Prefer Not to Fill Out the Form Online?

Mental Health and Secure Transport Booking Form

Young People and looked after children Booking Form