Date:
To:
From:
Re: Paratransit Physician Verification Letter
Patient Name:

To Whom It May Concern,

I am a licensed physician and I am writing to verify that the individual named above has a disability that prevents them from using conventional public transportation services. Based on my professional assessment, this individual requires access to paratransit services.

Diagnosis/Description of Disability:
Impact on Ability to Use Regular Transit:
Duration of Disability:
Additional Comments:
Physician Name:
License Number:
Practice/Facility:
Phone:
Address:
Signature
Date: