Request a Ride - River Valley Senior Center

Have you used our service before? *

Are you 60 or older? *

used a Home

Do you live in our service area of Bridgman, Galien, Grand Beach, Harbert, Lakeside, New Buffalo, New Troy, Three Oaks or Union Pier? *

Do you need a wheelchair accessible van? *

Do you need assistance to/from van? *

i.e. walker, transfer chair, vision impairment, etc.

If you will need assistance, please let us know how below.

Name *

First

Last

Full Home Address *

Phone Number *

Appointment date: *

Appointment Time: *

How long do you estimate your appointment to take? *

Name of Doctor:

Facility Name: *

Facility Full Address: *

13321 Red Arrow Highway PO Box 275 Harbert, MI 49115