Formulaire

Request for prior transport agreement - medical prescription for transport (Form 11575*08)

Cerfa 11575*08 (S3139h)

Form template posted online for information

For your procedure, you must use the original form provided by the health professional.

    Fill out the form

    For details, please use the practical information sheets :

    J'ai réalisé une démarche administrative

    Je donne mon avis sur Services Publics +. L'administration concernée me répondra.

    Je donne mon avis

    Émetteur du formulaire administratif : National Health Insurance Fund (Cnam)

    Verified 03 October 2025 - Directorate of Legal and Administrative Information (Prime Minister)