Winscombe Contact Scheme

"Winscombe's Good Neighbour Scheme"

3 Transport to Medical Appointments

3.3 Request for Transport

A resident can request transport by contacting the Transport Co-ordinator by phone 07888 812398 or by using the Transport request form below:

Request for Transport Form
Your Name
Patient's Name (if different from requester)
Address
Post Code
Home Phone Number
Mobile Phone Number
Email
Day, Date and Time of Appointment
Expected length of Appointment (if known)
Place of Appointment
Other Location
Do you have a disability badge?   Tick if Yes
Do you have difficulty walking?   Tick if Yes
Do you need to take any large walking aid?   Tick if Yes
    If yes, please list items:
Will you be accompanied?   Tick if Yes
    If yes, please give name: