To request a Free Eligibility Assessment, please complete the form below and review your answers before submitting your information*. Once submitted, you will be contacted by a knowledgeable Client Administrator within 2-3 business days to discuss your inquiry.

*Your information is secure and will not be shared with any third parties without your written consent. Your information will remain confidential and will be used strictly for the purposes of disability tax related assessments.

Your Name*

Phone Number*

Email Address*

_______________________________________

Name of Person with Disability (PWD)*

What is the Age of the PWD?

Province of Residence

Nature of the Disability

Year Disability began

Questions/Comments


*a required field.