WSIB Book A Ride

Make Sure to Fill Out All Required Fields…
After You Click The Send Button Watch
For The Message Saying
“Thank you for your message. It has been sent.”

    Client Name*

    Client Mobile Number*

    Escort*

    Escort Authorized For Solo Travel*
    YesNo

    ID Number*

    Approved Pickup Address*

    Approved Drop Off Address*

    If Additional Approved Addresses:

    Activation Date*

    Activation Time*

    End Date*

    End Date Time*

    Special Request*

    Service Code*

    Senders Name*

    Senders Email*