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Application Form

To apply for Handi-van, please review the Handi-van Application instructions carefully in the attachment below. NOTE: The application process requires the submission of two (2) forms: Part A (for applicants to complete) and Part B (for medical professional's to complete). BOTH forms must be completed in full and submitted at the same time.

Handi-van Application

Completed Handi-van Applications will only be accepted via mail or fax (905-335-7878). If sent by fax, please also mail original to:

Burlington Handi-Van
3332 Harvester Rd.
Burlington, ON, L7N 3M8