Access-a-Ride Medical Provider Form

Instructions for Medical Providers

In order to prevent delays in your patient's application, please follow these instructions:

Complete the Medical Verification Form

Download and print the form below titled "Access-a-Ride Medical Verification Form 2023"

Sign the Medical Verification Form.

Remind the patient that the Application for Paratransit service needs to be completed and submitted if not included with this form.

Health care providers who can complete this form (must be treating the disability for which applicant is applying for paratransit service):

• Physician
• Psychiatrist
• Respiratory Therapist
• Optometrist
• Chiropractor
• PT / OT
• Social Worker (MSW)
• Mental Health Clinician
• Rehabilitation Counselor
• Orientation & Mobility Specialist
• Registered Nurse
• PA / NP
• Psychologist
• Ophthalmologist

Submit the Medical Verification Form

Fax the completed form (2 pages) to 303-299-2169 OR return the printed form to your patient.