ROSSS - Transportation

Are you a current client? *

Please note that new clients are required to undergo an intake interview to determine their eligibility, as well as to review the role and responsibilities of the client, the driver and the agency providing the service. This must be completed before the first ride is booked.

First name *

Last name *

Telephone Number *

Email address *

(Used to send you a confirmation email)

Please use the calendar below to select the date of your requested ride. Requests must be submitted a minimum of 3 business days prior to the appointment date. You can book a ride up to 4 months in advance. Dates in which service is not available are marked in red.

Date of ride *

Appointment Time *

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

Mobility Needs *

Will anyone be accompanying you? *

One-Way or Round Trip *

Transportation Type *

*

(Click on SHOW ROUTE)

*

(Click on SHOW ROUTE)

Pick-up Address *

Drop-off Address *

Message: (Please note your required arrival time at your appointment if it is earlier than the appointment time, and 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). *

Please note that new clients are required to undergo an intake interview to determine their eligibility, as well as to review the role and responsibilities of the client, the driver and the agency providing the service. This must be completed before the first ride is booked.

Referrer Information

Client Information

Please use the calendar below to select the date of your requested ride. Requests must be submitted a minimum of 3 business days prior to the appointment date. You can book a ride up to 4 months in advance. Dates in which service is not available are marked in red.

Please select additional dates in January 2022

Please select additional dates in February 2022

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, a Transportation Coordinator will contact you within 1 business day to confirm that your request has been received. You will receive confirmation of the ride booking details (name of driver, pick up time) closer to the date of your appointment.

Frozen
Meals On Wheels

Hot
Meals On Wheels

Foot Care

Grocery Bus

Congregate Dining

Please note that new clients are required to undergo an intake interview to determine their eligibility, as well as to review the role and responsibilities of the client, the driver and the agency providing the service. This must be completed before the first ride is booked.

Referrer Information

Client Information

Please use the calendar below to select the date of your requested ride. Requests must be submitted a minimum of 3 business days prior to the appointment date. You can book a ride up to 4 months in advance. Dates in which service is not available are marked in red.

Please select additional dates in January 2022

Please select additional dates in February 2022

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, a Transportation Coordinator will contact you within 1 business day to confirm that your request has been received. You will receive confirmation of the ride booking details (name of driver, pick up time) closer to the date of your appointment.

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