Online requests must be made at least 72 hours (3 days) prior to the requested trip. Please be aware that filling out this form does not guarantee that your trip will be approved - iRIDE staff will contact you with trip confirmation. Please note that this form is monitored Monday through Friday from 8:30 a.m. to 4:30 p.m. INFECTION PREVENTION SCREENER: Do you/anyone in your household have a new/worse cough or shortness of breath? Are you/anyone in your household feeling feverish, or had shakes or chills within the last 24 hours? (fever greater than 38 degrees Celsius) Have you/anyone in your household travelled outside of Canada in the last 14 days? Have you/anyone in your household had close contact with a person with symptoms who has travelled outside of Canada in the last 14 days? If you answer yes to any of these questions, please call our office for further instruction, and do not fill out the form below. Client First Name (required) Client Last Name (required) Client Home Phone Number (required) Client Cell Phone Number Client Home Address (required) Client Home City/Town (required) Email Address (required) Primary Contact Name (if different from client) Primary Contact Phone Number (if different from client) Date of Ride (required) Appointment Time (required) Return Time (required) Destination Address - include suite number if applicable (required) Destination City/Town Destination Contact Name or Department (required) Destination Phone Number (required) Will there be a support person? (required) Yes No Will any mobility aids be used? (required) Yes No How would you prefer to be contacted? (required) By EmailBy Telephone Special Instructions Privacy Disclaimer: By submitting this form, you are consenting to being contacted by iRIDE to complete the booking of your ride.