Care Centre Visitor Request Form
Please note all fields marked with an asterisk must be completed to submit the form.
Please select the type of visit you wish to request.
If you selected an Outdoor Visit above, in case of inclement weather, would you like to have your visit indoors?
Please note if "Yes" rapid test will be required at the time of visit.
Name of Resident
Location of Resident's Room or House
Visitor Contact Information
Name of Visitor(s)
If there are multiple visitors, please list ALL names of visitors.
Which visit length would you prefer?
If you selected Other above, please indicate the amount of time you'd like to request.
Select preferred time block.
Indicate preferred days of the week.
Please indicate all the days that work best for you schedule.
Are you bringing any drinks or food items for the resident?
If yes, please indicate in the text box the details of what you plan on bringing.
If you have any additional details about your request please add them in the space below.
To avoid delays, please review all contact information to ensure that it has been entered correctly.
If your application was successfully received you will receive a confirmation that your request has been submitted successfully. Only call if you did not receive confirmation.