Transport Service – Coffs Harbour

Date of service
Please provide us with at least 24 hours notice of service required. For shorter notice bookings, please call 0418 425 504.

Time you need us to arrive for pick up

AMPM

How long will you need us?
We charge in hourly increments. How many hours do you estimate this service will take?

Name of the client
Who are we transporting?

Client's Date of Birth

Where are we picking up the client?
Please provide the full address and any additional directions we will need.

Details about the service required
Please provide information regarding the purpose of the service (eg. to escort client to medical appointment, transport and escort for shopping, attend social activity etc)

Risks
Please provide ANY information regarding any health or risk information our staff will need to be aware of to perform this transport service to keep your client safe. Please check any of the boxes applicable to your client:
Falls RiskBehaviour Management IssuesIncontinence IssuesWheelchair AccessibilityNoneOther

Wheelchair details
If you require wheelchair-accessible transport, we may need to book a special vehicle.

Is your wheelchair motorised?
YesNo

Is your wheelchair a push/manual chair?
YesNo

How heavy is your manual wheelchair (approximately)?

(Please note that while our wheelchair-accessible vehicle is suitable for most motorised wheelchairs, the inclination of the ramp requires that manual wheelchairs have a maximum weight limit of 80kg for the combined weight of you and your manual wheelchair).

Any other health or risk information we need to be aware of?
Please provide us with ANY additional information we should be aware of regarding your client or the service they require, in order to keep your client and our staff safe.

Mobility
Can you move independently from your home to the kerb side?
YesNo
Can you manage 2 to 3 steps independently?
YesNo
Do you need to use a mobility aid or any other equipment when you travel?
YesNo
If yes, please list below

Care Plan
If there is a Service or Care Plan you wish to include, to assist us in providing this service, please attach it here. PDF File please with max. file size: 10 MB.

During the service, will the client need money to:
Please tick any applicable expenses
Pay for medical appointmentPay for car parkingPay for taxiPay for shoppingPay for anything elseNo, they won't need money

During the service, will the client need to take:
Please tick any applicable options
Medicare cardHealth Care CardMedical recordsAny additional paperworkMedicationsNo, they won't need to take anything

Who should Subee invoice for this service?
Please provide full name and address of invoicee

Name of your Nursing Home or Care Service

Name of person booking this service

Phone number of person booking this service

Email address of person booking this service

Confirmation
Please click here to indicate you have provided us with the necessary information (such as health, risks and requirements) our staff will need to be aware of to perform this transport service and to keep your client safe.
Yes, all necessary information has been providedWe agree to a 48 hour cancellation period, otherwise the client, or facility booking the service, will be responsible to pay %100 of the service cost.