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Please fill in all required fields, bold and marked with *

Booking Contact

Name
Telephone #
E-mail*

Passenger Info

First Name*
Last Name*
Claim / Policy #
Date of Loss
Telephone #*
Alternate Telephone #
E-mail
Home Address
Passenger Info




Additional Info and Special Instructions

Appointment Schedule

Enter dates, times and locations of appointments.
For recurring appointments enter all dates and times in one box.
1.*
2.
3.

Billing Info

Contact Name
Insurance Company
Telephone #
E-mail
Fax
Billing Address
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Book a Ride

If you need an urgent booking, less than 24 hours, please call us.

Southern Ontario

289-700-3359

Eastern Ontario

613-233-3450

Toll Free

888-407-0114

Online Tools

Instant Quote
Get an instant quote simply by entering 'from' and 'to' addresses.
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Service Area
Go Rehab provides insurance pre-approved transportation to individuals undergoing treatments or assessments.
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Contact Info
Email

info@GoRehab.com

Toll Free

(888) 407-0114

Southern Ontario

(289) 700-3359

Eastern Ontario

(613) 233-3450

Fax

(613) 233-3487