Upload an acceptable form of identification
Upload proof of residency
Please provide a name and telephone number of a contact person in the event of an emergency.
Please answer the following questions - your specific answers to the questions will familiarize us with your individual needs.
Age and Disability verification
Applicants between the ages of 18-54 must provide proof of disability. Select the proof of disability you will provide:
Upload a scan of your Medicare card in jpg format
Upload a scan of your receipt in pdf or jpg format
Upload a scan of your RTC card in jpg format
Upload a scan of your certification with East Bay Paratransit in pdf format
The link above will open in a new window and allow you to print the Authorization for Use or Disclosure of Patient Health Information form. This form authorizes R-Transit to obtain information from your physician regarding your disability. Once completed and signed, you will scan the form below.
Upload your signed form in pdf format
The link above will open in a new window and allow you to print the Disability Verification form. This form must be filled out by your healthcare provider. You may upload the completed and stamped form below.
Upload the completed and stamped form in pdf format
By checking the box and typing my name below, I am electronically signing my application. I understand all information will be kept confidential and only the information require to provide the services will be disclosed to those who perform the service.
This field is not part of the form submission.
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