Medical Transportation Application
Are you a Nisga’a Ts’amiks member who requires a ride to any of the following:

- medical appointment
- Pick up your prescription
- Get your Flu shot
- Get your Vaccine or Booster done

If so, we can assist you. Kindly fill out this application and return it to our office by either mail, email OR in person with an appointment card or email with appointment info. (Email listed below) Applicant must be a registered Ts’amiks member.
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Full Name
Citizenship Number
Date of Birth
MM
/
DD
/
YYYY
Address
Phone Number
Email
Appointment Date
MM
/
DD
/
YYYY
Appointment Time
Time
:
Appointment Location
Prescription Pick-Up Location
Submit
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