SEPTA Access requires this form with every ADA paratransit application: a licensed or certified professional describes the applicant's functional skills for riding regular SEPTA buses and light rail. Applications that arrive without it are returned. Once SEPTA Access receives the complete packet, it schedules an in-person functional assessment.
The professional most familiar with the applicant completes the whole form (pages 5 to 9 of the ADA Application Packet) and records a Pennsylvania license number: a physician, PA, psychiatrist, psychologist, OT, PT, social worker or case manager, or nurse practitioner. The applicant completes the application and the page 4 release.
Download the current version from the source each time; forms change without notice.
Functional Verification Form for Licensed/Certified Human Services and/or Health Care Providers
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
The licensed or certified professional most familiar with the applicant: a physician, physician assistant, psychiatrist, psychologist, occupational therapist, physical therapist, social worker or case manager, or nurse practitioner. The form records the professional's Pennsylvania license number, so it should come from someone who knows how the applicant functions day to day.
SEPTA Access returns the ADA application without processing it. The form is a required part of the packet, not an optional attachment, so a patient who mails the application without it loses time and has to resend the full packet before a functional assessment can be scheduled.
Once SEPTA Access receives the ADA application and the completed Functional Verification Form, it schedules the applicant for a functional assessment. The eligibility decision draws on both the professional's report and that assessment of the applicant's ability to use regular buses and light rail.