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Regional Transportation District

In order to prevent delays in your patient's application, please follow these instructions:
  1. Complete the Medical Verification Form in your web browser.
  2. Save a copy of this form on your computer. To do this, choose File – Print – Save as PDF in the destination field and select the location to save the document.
  3. Print the Access-a-Ride Professional Medical Verification Form.
  4. Sign the Medical Verification Form.
  5. Fax the completed form (2 pages) to 303-299-2169
    OR return the printed form to your patient
Health care providers who can complete this form (must be treating the disability for which applicant is applying for paratransit service):
  • Physician
  • PT / OT
  • Registered Nurse
  • Psychiatrist
  • Social Worker (MSW)
  • PA / NP
  • Respiratory Therapist
  • Mental Health Clinician
  • Psychologist
  • Optometrist
  • Rehabilitation Counselor
  • Ophthalmologist
  • Chiropractor
  • Orientation & Mobility Specialist

To be completed by the medical provider of AAR Applicant

Does the applicant’s disability prevent the applicant from getting to / from and riding the bus / light rail system?
Does this applicant need someone to accompany him/her at all times?

Does the applicant have the mental capacity, visual and/or hearing ability to:

Ask for, understand and follow directions?
Ask for assistance from appropriate sources?
Safely cross a major street?
Safely travel through crowded or complex facilities?
Recognize a destination or landmark?
Signal a bus operator to get off at destination stop?
Filter environmental noise?
Judge traffic flow?

Regarding vision impairments only:

Is the applicant able to locate steps or curbs?
Is the applicant impacted by bright sunlight?
Is the applicant limited by dimly lit conditions?
Is the applicant’s vision impacted at night?

Is the applicant, while using their mobility aid, able to independently:

Travel outdoors on their property?
Travel up to 1 block?
Travel up to 3 blocks?
Stand for up to 15 minutes with support?
Stand for up to 15 minutes without support?
Travel up or down hills?
These impairments are:

Does weather impact the applicant’s ability to travel?

Windy Weather
Cold weather
Hot weather
Please return this form to the applicant, or fax to 303-299-2169, once completed.