1401 S. Dort Hwy, Flint, Michigan 48503 | 810-767-0100 | TTY: 810-767-2795
| Family Service Agency/Senior Companion Program | |
|---|---|
| Street Address | |
| City | |
| Zip code | |
| Phone # | |
| Vehicles | |
| Number & Type of vehicles | |
| Passenger capacity for groups | |
| Phone # to arrange service (if different from main #) | |
| Advance notice needed for pick-up. | |
| Wheel chair lift available? | |
| Any restriction on destination? | |
| Curb to Curb or Door to Door? | |
Can an attendant ride along? | |
| If so, is there a charge? | |
| Service information for clients of Agency: | |
| Days of operation | |
| Hours of operation | |
| Service area | |
| Charge to passenger (State amount & specify:each way or round trip) | |
Service information for non agency clients: |
|
| Do you offer service to clients of other agencies or the general public? |
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| If Yes, complete these questions: | |
| Days of operation | |
| Hours of operation | |
| Service area | |
| Charge to passenger (State amount & specify:each way or round trip) | |
