DART uses this one-page version of its physician verification for paratransit applicants whose disability is visual. The eye doctor names the eye disease or condition and its onset date, records visual fields or best-corrected acuity for each eye and both eyes, and gives a prognosis. The form is designed to confirm that the patient is legally blind in both eyes.
A licensed ophthalmologist (MD) or optometrist (OD) who currently treats or formerly treated the patient completes and signs it with license number and state. The applicant completes DART's certification form for a visual disability.
Download the current version from the source each time; forms change without notice.
Physician Verification of Disability Form (For Visual Impairments) - DART Paratransit Services
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The form states it must be signed by a licensed optometrist or ophthalmologist, with credentials shown as MD or OD. The signer verifies that the diagnosis has been reviewed, is accurate and represents the applicant's current visual impairment, and indicates whether they treat the patient now or did previously.
Visual fields or visual acuity with best correction for the right eye, the left eye and both eyes; the form says both eyes must be completed. The doctor also names the eye disease or condition, its onset date and prognosis, and marks the impairment as permanent or time-limited in months.