Client Registration

Register today using the online form for yourself, a family member, or a friend.

Registration is the first step to utilizing the Saugeen Mobility service.
Please fill out our online form below and submit it by clicking the "Submit" button
at the bottom.

It is essential to indicate that you have a large wheelchair, tilt wheelchair, wheelchair with leg extensions or a standard wheelchair on the registration form to ensure the appropriate vehicle is assigned for your transportation needs.

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This field is for validation purposes and should be left unchanged.

Client's First Name(Required)

Client's Last Name(Required)

Residential Facility (If Any)

Primary Contact Phone(Required)

Secondary Phone

Address Information(Required)

Street Address Address Line 2 City Province Postal Code

BILLING INFORMATION - Complete ONLY if different from above

Full Name

Billing Address

Bill to different address

Check this box to enter a different billing address and contact person

Billing Address

Street Address Address Line 2 City Province Postal Code

Relationship

Example: Sibling, Parent, POA, Care Giver

Are You an ODSP/ONTARIO WORKS Client? If YES, please indicate:

ODSP

ONTARIO WORKS

If YES, please indicate Case Worker Name

Send Bills to ODSP/ONTARIO WORKS Directly?

Yes

No

Would you like to have your invoice sent to you by email?

Yes

No

Send my invoice to this email

MOBILITY AIDS, ETC

Please indicate what mobility aids you are using. If you are using a wheelchair, please provide the dimensions (30 or 24 inches wide). This will assist us in sending the correct vehicle.

Wheelchair & Equipment Information

Please indicate what mobility aids you are using. If you are using a wheelchair, please note we have a maximum wheelchair width of 34 inches.

Type of Wheelchair(Required)

I don't use a wheelchair

Standard (30 inches wide from wheel to wheel)

Large (34 inches from wheel to wheel)

A wheelchair measuring more than 30 inches wide would be considered Oversized.

Wheelchair Modifications

Power chair

Tilt Chair

Leg Extensions

Other Equipment

Cane

Walker

Scooter *Must transfer independently to seat of vehicle*

Oxygen

Other

Do you travel with a Service Animal? *Certification Required*

Yes

No

List Additional Equipment Here(Required)

Medical Conditions & Other Information

Please indicate any medical conditions or other information you feel our staff should know about.

Attendant

Should you need a person to assist you, that person may ride with you as an attendant, free of charge. Driver will not enter a private residence, but will assist you from your door to the vehicle and from the vehicle back to your door at the end of the ride.

Challenge Description

Please describe your challenges(Required)

Emergency Contacts

You must list at least one emergency contact

Contact 1

Full Name(Required)

Relationship(Required)

Example: Sibling, Parent, POA, Care Giver, trusted person

Primary Phone(Required)

Secondary Phone

Contact 2

Full Name(Required)

Relationship(Required)

Example: Sibling, Parent, POA, Care Giver, trusted person

Primary Phone(Required)

Secondary Phone

Confidentiality

Please be assured that all the information collected on this form will be kept strictly confidential and will not be released without your permission!

Name of person filling out form(Required)

Relationship(Required)

Example: Sibling, Parent, POA, Care Giver, trusted person

Contact email address for person filling out form(Required)

Enter Email Confirm Email

By checking this box, I am stating that all the information supplied here is correct.(Required)

I verify this information to be correct

How did you hear about us? (Example: Referral from a friend, flyer, etc.)

Severe Weather Conditions

In case of severe weather conditions where SMART has determined in its sole and absolute discretion that it is unsafe to operate the Vehicle and/or provide the Transportation Services, no Transportation Services shall be provided (“Severe Weather Cancellation”). In such cases, the assigned SMART driver will contact Eligible Clients impacted by the Severe Weather Cancellation directly via telephone, to advise them of the Severe Weather Cancellation. On the next business day, the assigned SMART driver will contact the SMART’s office and inform dispatch about the Severe Weather Cancellation. There shall be no User Fees and/or Penalty Fees charged for Transportation Services cancelled due to Severe Weather Cancellations.

More Information

Policies

Saugeen Mobility & Regional Transit

Since 1977, SMART has been serving members of the community. We are a specialized public transit service for those with mental or physical challenges, visual and/or cognitive impairments. Register today, schedule a ride and begin using the service. Our modern fleet of vehicles is standing by!