Transportation Request Form

Please be advised that HHHS Community Support Services requires a minimum of 4 business days notice for booking transportation trips. HHHS offers a medically necessary subsidy for any clients who are receiving Cancer and Dialysis treatments. Please reference this subsidy to your coordinator for more information. Filling out this form does not guarantee your trip can be completed. If you have not had confirmation from a driver or support staff within 48 hours of your request, please call 705 457 2941 ext. 2925 to confirm your booking.

Transportation Rates

Private Pay Rates Van Rates
$0.35/KM $0.50/KM
$10/hr Wait time $50/hr Wait time

Book a Ride:

I'm filling out this form for: *
Who is this ride being billed to? *

Who is taking the ride?

Trip Details *
Will anybody be accompanying you on your ride? *
Trip Type *

Where Are We Picking You Up?

Where Do You Want To Go?

How long do you expect your appointment to be? *

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Programs and Services of Haliburton Highlands Health Services are funded by the Ministry of Health and Long-Term Care.

Hospital Accreditation

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