Proudly providing non-urgent, patient transportation within the Ottawa Valley since 2008.

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Transportation Request Form

To make a transportation request please complete the form below. If you need help please click on the Help Me button.

Once your transportation request has been sent, a service representative will contact you within one business day to confirm if we can accommodate your request. For same day bookings please call our office at (613) 226-6098.

Please note that fields with an * are required.

Are you a current client? *

Referrer Information

First Name *

Last Name *

Telephone Number

Email *

Client Information

First Name *

Last Name *

Telephone Number

Email *

Date & Time Of Ride *

Click here for calendar.

Transportation needs *

Please let us know your transportation needs.

Will you have portable oxygen with you? *

Yes (Extra charges may apply)
No

Appointment Time *

Click here to set appointment time.

Will anyone be accompanying you? *

Do you require a stair chair? *

Yes (Extra charges may apply)
No

Please note any additional mobility or accompaniment needs along with any precautions we should be aware in the message box below.

Pick-up Address *

Drop-off Address *

Please click on the review and confirmation button below to confirm the following:

Review *

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

Privacy Policy *

I have reviewed the privacy consent policy.

View Our Privacy Policy

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