Patient Travel Request Form [#4]
  • Date
  • Patient Details
  • Escort Details
  • Travel Details
  • 2nd Appointment Details
  • Hotel Details

HEALTH DEPARTMENT

PATIENT TRAVEL REQUEST FORM

This form MUST be FILLED OUT COMPLETELY and SUBMITTED as soon as you know of your appointment DATE & TIME

Please attach a COPY of your APPOINTMENT CONFIRMATION from the Doctor's Office.

This will ensure that all the details of your trip are arranged and your travel warrant is complete for processing prior to your appointment.

Please Note
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OUR STORY

The Mowachaht/Muchalaht First Nation is a community with a deep connection to the land and sea. For thousands of years, our people have depended on the ocean, rivers, and forests to sustain our way of life. Our ancestors were skilled whalers, fishermen, and traders, and our territory was a hub for commerce and cultural exchange.

Despite facing challenges from colonialism and residential schools, the community is committed to preserving our culture, language, lands, and waters. We aim to create economic opportunities for our citizens and the broader community while maintaining our connection to the water.

Our values of Hisukʔis cawaak (Everything is one), ʔiisaak (Respect with caring), and ʔuuʔaaluk (Taking care of) guide us to a better future.