west parry sound district community support services
Service Request Form
Important Confidentiality Notice: Please do not include any client-privileged, private, or highly sensitive information in this service request form (e.g., protected health information (PHI), financial data, or legal case details). This form is for general service inquiries only. Communications made through this form may not be secure or confidential, and submitting such information does not create a formal professional-client relationship or privilege until we have confirmed our ability and willingness to represent you or provide services through a formal agreement. If your request involves sensitive information, please contact us by telephone to arrange for a secure method of communication. By submitting this form, you acknowledge and agree to these terms. Our phone number is 705-746-5602.
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Are you an agency, organization, family, friend or would like to know for yourself about more in-depth information about how we may assist you in providing opportunities to our home and commnity-based programs?
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Pease fill the form out below or you may print it off as well. Thank you.
Service Request Form Hard Copy
​If you prefer a hard copy, below is the service Request Form. You may fax it to 705-746-5705 or mail it to 60 James St. Parry Sound, Ontario P2A 1T5. We will get back to you shortly upon arrival. Thank you.