Online Vehicle Request Form

Please note that all fields marked with * are mandatory.

If your request is sent after 19:00 hours and you require immediate assistance, please call our dispatch directly at 613-727-0168 or 1-866-561-7787.

Patient Information

 

Transfer Information

Pick-up Date: Pick-up Time: Appointment Time:
Pick-up Location:
Destination Location:
Transfer By: Obstacles:
Est. Return Time: DNR: Escort:
Wait Time Required: