Request a Drive Online

Book Drive Online

The passenger that is requesting a ride is currently a registered CAP client. If the passenger is not currently registered, registration is free and easy. Please complete the New Client Registration form.

Yes, the passenger is a registered CAP client.

Passenger First Name

Passenger Last Name

Has your address changed?

Yes

Passenger Address

Address Line 1

Address Line 2

City

Province

Postal Code

Passenger Phone

Passenger Email

Will a guest be accompanying the patient to the appointment?

Yes

If you are requesting multiple rides and have access to your hospital appointment schedule, please upload a photo of the schedule. Indicate the dates transportation is required either by marking them on the schedule or by listing them in the box below.

Choose File

Which appointments on the uploaded schedule require rides?

Schedule All Appointments

Schedule Selected Appointments

Please indicate the dates from the uploaded hospital appointment schedule for which transportation from CAP is required.

Do the appointments require a return trip?

Book Return

One Way Only

If you are unable to upload a hospital appointment schedule and need to request a single ride or up to 5 additional rides, please complete the information below.

I need to request a ride individually.

Yes

Date of Appointment 1

Time of Appointment 1

Appointment 1 Type

If you selected “Other” for appointment type, please provide additional details.

Approximate Appointment Length

Appointment 1 Location

If you selected “Other” for appointment location, please provide additional details.

Does this appointment require a return trip?

Yes, book return

No, one way only

Requesting a second drive?

Yes

Date of Appointment 2

Time of Appointment 2

Appointment 2 Type

If you selected “Other” for appointment type, please provide additional details.

Approximate Appointment Length

If you selected “Other” for appointment location, please provide additional details.

Appointment 2 Location

Does this appointment require a return trip?

Yes, book return

No, one way only

Requesting a third drive?

Yes

Date of Appointment 3

Time of Appointment 3

Appointment 3 Type

If you selected “Other” for appointment type, please provide additional details.

Approximate Appointment Length

Appointment 3 Location

If you selected “Other” for appointment location, please provide additional details.

Does this appointment require a return trip?

Yes, book return

No, one way only

Requesting a fourth drive?

Yes

Date of Appointment 4

Time of Appointment 4

Appointment 4 Type

If you selected “Other” for appointment type, please provide additional details.

Approximate Appointment Length

Appointment 4 Location

If you selected “Other” for appointment location, please provide additional details.

Does this appointment require a return trip?

Yes, book return

No, one way only

Requestinga fifth drive?

Yes

Date of Appointment 5

Time of Appointment 5

Appointment 5 Type

If you selected “Other” for appointment type, please provide additional details.

Approximate Appointment Length

Appointment 5 Location

If you selected “Other” for appointment location, please provide additional details.

Does this appointment require a return trip?

Yes, book return

No, one way only

Is the contact person different than the patient?

Yes

Contact Person First Name

Contact Person Last Name

Contact Person Phone

Contact Person Email

Preferred Method of Communication

Phone

Please allow up to 24 business hours for a response. Submitting a Drive request online does NOT guarantee transportation. Drive requests may be submitted by clients or caregivers on behalf of a client. Once your request has been received, our Drive Coordinator will contact you using your preferred method of communication.

I understand that submitting this request does not guarantee transportation.

Request a Drive Online

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