Request an iRIDE Trip to a Vaccination Clinic

Trips will be scheduled on a first come first served basis and 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.

Eligibility: 

Please note this service is available for older adults over the age of 65 who live within our catchment area.

Important Information
Older adults who are cognitively impaired MUST be accompanied by a caregiver. We do not provide supervision/caregivers for clients. Upon arrival, the senior must be able to follow instructions or signage to get to their appointment.

I have read the eligibility requirements and important information and fit the criteria for the service.*
Client Name*
Client Home Address*
Primary Contact Name (if different from client)
Date of Ride & Appointment Time*
:  

Please note that your return trip will be scheduled for one hour after your appointment time.

Vaccine Clinic Address*
Will there be a caregiver/support person joining the client on the trip?*
Do you use a wheelchair?*
Will any mobility aids be used? (i.e. cane, walker)*

Privacy Disclaimer: By submitting this form, you are consenting to being contacted by iRIDE to complete the booking of your ride to the vaccine clinic.

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