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Quinte Access: Specialized Service: Registration

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Register for Specialized Services

Eligibility – to be eligible for our service, you must

How to Register

Quinte West and Brighton Residents:

  • Complete the registration form and send by:
    • Email: quinteaccess@bellnet.ca
    • Mail or in person: 97 Front Street, Trenton, ON K8V 4N6
    • Fax: 613-392-3872
  • Or call our office at 613-392-9640

Download our Registration Form (MS-Word) or complete and submit the electronic form below.

Client Information
* indicates required response
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Mobility*:

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Birth Date*:



Gender*:

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Medical/Disability Information


Main purpose(s) for requesting service* (check as many as applicable)

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On what basis do you need our services?*

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Attendant Required?*:

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Are you able to climb steps?:*

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Emergency Contact





Backup contact person:





* Please note that if eligibility of an applicant is questioned, a doctor's certification of medical history may be requested. Information provided will be kept in the strictest of confidence. Please consult our Privacy Policy for details of how we use and store your confidential information.

By submitting this form, I certify that due to a Medical Condition and/or am a senior, I am unable and/or find it difficult to use other traditional means of transportation and require your assistance with transportation.

No signature is required when submitting this form electronically.

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