Home Visit Safety Checklist

  • The prospective client seeking in home service fills out the form prior to the onset of service. The information is used to make a determination to proceed with in home counselling. Mileage and travel fees apply.

  • Date Format: MM slash DD slash YYYY
  • NOTES: paste the following link into your search bar for mileage rate (.54/km) .

    http://www.njc-cnm.gc.ca/directive/index.php?lang=eng&svid=97-%28