Booking Form Please provide us with 2 to 3 weeks notice for bookings. Every effort will be made to accommodate short notice bookings. Please phone 613-264-8256 or 1-877-445-5777 for timely assistance. Please enable JavaScript in your browser to complete this form.Appointment InformationDate and Time of Your Appointment *DateTimeLocation/Address of Your Appointment *Length of Visit *Pickup Location *Personal InformationName *FirstLastAddress *Address Line 1CityState / Province / RegionPostal CodePhone *Email *Additional InformationAre you registered with either the Ontario Disability Support Program (ODSP) or Ontario Works (OW)?ODSPOWNoIf yes, please provide the name of the doctor, registered nurse or nurse practitioner you will be visiting, or the name of the program you will be attending.Do you require an accessible vehicle (for wheelchair or other mobility devices)? *YesNoIf someone will be escorting you, please indicate their name in the box below. Your worker will have to contact us with approval for this trip. Submit