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ACCESS LYNX TD Application: Medical Section 4

ACCESS LYNX runs the Transportation Disadvantaged (TD) program, a state-funded shared-ride, door-to-door service for eligible residents of Orange, Osceola and Seminole counties. Applicants must meet two of three criteria: no access to a fixed route, a disability, or individual income at or below 185% of the federal poverty level. When disability is one of the two, a licensed medical professional completes Section 4, the medical form.

Who completes it

The applicant completes Section 1 (general information), Section 2 (income verification) and the signed acknowledgments. A licensed medical professional completes and signs Section 4, giving a medical license number and contact details.

Submitting and payment

How to submit it
The applicant returns the whole application, with a copy of a Florida ID or driver's license and income documents, to ACCESS LYNX Eligibility by mail (the form also lists a fax option). Processing can take up to 21 days from receipt of a complete application.
Who pays
The form does not address payment for completing the medical section.

Good to know

  • Section 4 asks for the condition type (cognitive, functional, hearing, visual, uncontrolled fatigue, emotional, neurological), whether it is permanent or temporary, and the expected duration if temporary.
  • The provider checks affected functions such as orientation, gait or balance, judgment, short-term memory and communication, and can mark 'Do Not Leave Unattended' for riders who need supervision.
  • A medication question asks whether prescribed drugs enhance or diminish the person's ability to travel independently. Answers must rest on an actual impairment that substantially limits a major life activity.
  • The certification warns that false or misleading medical information is fraud and a felony under Florida law. ACCESS LYNX may also request more information before deciding.

Get the official form

Download the current version from the source each time; forms change without notice.

ACCESS LYNX Transportation Disadvantaged (TD) Program Application - Medical Section (Section 4)

Official pagePDFVersión en español

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who can complete Section 4 of the ACCESS LYNX TD application?

The current application asks for a licensed medical professional, who signs, prints their name and gives a medical license number. Older versions of the TD application asked specifically for a Florida-licensed physician, so patients should use the current 08/2025 form from the ACCESS LYNX application page.

Does every TD applicant need the medical section?

No. Applicants qualify by meeting two of three criteria: no fixed-route access, a disability, or low individual income. Section 4 is needed only when disability is one of the criteria used. Someone with no bus access and qualifying income can apply without a medical certification, though income must be documented.

Is the ACCESS LYNX TD application available in Spanish?

Yes. ACCESS LYNX publishes the TD application in English and Spanish, and the medical section appears in both versions. The program's ADA paratransit service is a separate application, and applicants are asked to apply only for the program that fits their needs.