Goldsmith Medical - Transportation

Transportation - Service Request Form

To make a transportation request please complete the form below. If you need help please click on the Help Me button.

Once your transportation request has been sent, a service coordinator will contact you within 1 business day to confirm if we can accommodate your service request.

If booking is less than 24hrs please call the office at (613) 226-6098.

Please note that fields with an * are required.


(Used to send you a confirmation email)

Please use the Date of ride calendar below to select the date of your requested ride.

















Please note any additional mobility or accompaniment needs along with any precautions we should be aware in the message box below.

Please click on the review and confirmation button below to confirm the following:







Once your transportation request has been sent, a service coordinator will contact you within 1 business day to confirm if we can accommodate your service request.