How Can We Help?

The information contained in this request form is forwarded directly to the National Victim Services Director of MADD Canada.

Select your region:

Is this the first time that you are visiting our website?

YesNo

Was someone in your family killed in an impaired driving crash?

YesNo

If yes, who did you lose:

ParentChildPartnerSiblingGrandparentAunt/uncleNiece/nephewOther

Were you or a family member injured in an impaired driving crash?

I was injuredParentChildPartnerSiblingGrandparentAunt/uncleNiece/nephewOther

Was the driver charged with an impaired driving offence?

YesNoDon’t know

Have you consulted a personal injury lawyer?

YesNo

Have you been contacted by your local victim services?

YesNo

Would you like to receive information relating to Victim/Survivor Issues from MADD Canada?

YesNo

What topics would you like to receive information on?

Grief and LossCoping with InjuryA Victims Guide to the Criminal Justice systemA Victims Guide to Personal Injury LawMADD Canada Victim ServicesRemembering and Honouring victims and survivorsSomeone You Love Drove While ImpairedSurvivor GuiltHelping Children Deal with LossTeenager GriefWitnessed an Impaired Driving Crash

Additional comments:

First Name:

Last Name:

Address:

City:

Province:

Postal Code:

Email:

If you are in need of immediate support, please contact the Victim Services Manager of your region:

  • Gillian Phillips, Western Region (MB, SK, AB, BC, YT, NWT) at 1-866-461-4077 or via email at gphillips@madd.ca
  • Steve Sullivan, Ontario Region at 1-866-876-5224 or via email at ssullivan@madd.ca
  • Marie Claude Morin, Quebec Region at 1-877-392-6233 or via email at mcmorin@madd.ca
  • Gloria Appleby, Atlantic Region (NS, NB, PE, NL) at 1-866-381-8310 or via email at gappleby@madd.ca