WOCRC - Transportation

Are you a current client? *

First name *

Last name *

Telephone Number *

Email address *

(Used to send you a confirmation email)

Please use the Date of ride calendar below to select the date of your requested ride. Services are available to order on-line from between 7 to 40 days of today's date excluding statutory holidays. Dates in which service is not available are marked in red.

Date of ride *

Appointment Time *

Return Pick-up time *

Would you like to request additional rides to the same address in the next 30 days? *

One-Way or Round Trip *

Transportation Type *

*

Pick-up Address *

Drop-off Address *

Message: (Please note any additional mobility or accompaniment needs in the message box below)

Please check each box below to confirm the following:

Please leave this field empty

       I confirm that the pick-up and drop-off addresses are correct *

       I acknowledge the cost listed is only an estimate *

       I have reviewed the transportation program policy (click here to review). *

       I have reviewed the privacy consent policy (click here to review). *

Referrer Information

Client Information

Please use the Date of ride calendar below to select the date of your requested ride. Services are available to order on-line from between 7 to 40 days of today's date excluding statutory holidays. Dates in which service is not available are marked in red.

Please select additional dates in December 2018

Please select additional dates in January 2019

In order to calculate your route please ensure you have selected your mobility needs, entered a pick-up and drop-off Address, selected either one-way or round trip and Transportation Type.

Please check each box below to confirm the following:

I confirm that the pick-up and drop-off addresses are correct *

       I acknowledge the cost listed is only an estimate *

       I have reviewed the transportation program policy (click here to review). *

       I have reviewed the privacy consent policy (click here to review). *

Once your transportation request has been sent you will receive a telephone call on the Thursday prior to your appointment to confirm if we are able to meet your request.

Frozen
Meals On Wheels

Hot
Meals On Wheels

Foot Care

Grocery Bus

Congregate Dining

Referrer Information

Client Information

Please use the Date of ride calendar below to select the date of your requested ride. Services are available to order on-line from between 7 to 40 days of today's date excluding statutory holidays. Dates in which service is not available are marked in red.

Please select additional dates in December 2018

Please select additional dates in January 2019

In order to calculate your route please ensure you have selected your mobility needs, entered a pick-up and drop-off Address, selected either one-way or round trip and Transportation Type.

Please check each box below to confirm the following:

I confirm that the pick-up and drop-off addresses are correct * I acknowledge the cost listed is only an estimate * I have reviewed the transportation program policy (click here to review). * I have reviewed the privacy consent policy (click here to review). *

Once your transportation request has been sent you will receive a telephone call on the Thursday prior to your appointment to confirm if we are able to meet your request.

Frozen Meals On Wheels

Hot Meals On Wheels

Foot Care

Grocery Bus

Congregate Dining

I confirm that the pick-up and drop-off addresses are correct *

I acknowledge the cost listed is only an estimate *

I have reviewed the transportation program policy (click here to review). *

I have reviewed the privacy consent policy (click here to review). *

Frozen
Meals On Wheels

Hot
Meals On Wheels