Optio Membership Form

Reasons for using the service
If you use a walking aid, please tick

Emergency Contact

Is this a friend or relative?
Next of Kin
Please tick this box to consent to your next of kin discussing and booking appointments on your behalf ,

Membership fees

 Annual membership is £60 per person or £80 per couple (must be in same household).  Membership Renewable annually on 1st April.  If you join the scheme any time after 30th September, there will be a reduced membership charge of £30 for the remainder of that year.  Accompanying carers do not pay membership fees.
Membership required

Journey costs

 Journey costs start and finish at the driver’s address  All journey costs are payable to the driver on the day in cash — drivers will provide you with a receipt  There is a minimum charge of £3.00 for a journey (if it is under 6 miles). Journeys over 6 miles are charged at 0.45 pence per mile.  Car parking costs are free at the hospital, but must be paid for in all other locations.  Drivers will wait for up to an hour for you once you reach your destination. If they have to wait for over an hour, double mileage will be charged for the entire trip.  Cheques Payable to CAIW or Bank payments Community Action Isle of Wight Sort Code 54-10-34 A/C 14229072 State surname