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UTA Healthcare Professional Verification Form

Utah Transit Authority uses this two-page form to confirm a disability for its Reduced Fare FAREPAY card when the applicant has no other proof, such as a Medicare card. A licensed healthcare professional states that they examined the applicant, that the impairment falls within the ADA definition printed on the form, and how long it is expected to last.

Who completes it

The applicant applies for Reduced Fare separately, and UTA fills in its application ID. A licensed healthcare professional completes the verification section with license number and contact details, marks the impairment permanent or temporary with an expected length, and signs with title.

Submitting and payment

How to submit it
The applicant uploads the completed form with the online Reduced Fare application or brings it to a UTA customer service location.

Good to know

  • UTA checks the professional's license against the Utah Division of Occupational and Professional Licensing database as part of verification.
  • Example disabilities on the form include respiratory, cardiac or neurological conditions, dialysis, MS, mobility impairments, blindness, deafness, intellectual or developmental disabilities, and chronic psychiatric disabilities.
  • The Reduced Fare card issued after approval is valid for five years.
  • UTA paratransit eligibility is decided by a separate in-person evaluation; UTA publishes no healthcare professional form for paratransit.

Get the official form

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

Utah Transit Authority (UTA) Healthcare Professional Verification Form

Official pagePDF

Fill it with Vero

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.

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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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

When does a UTA rider need the Healthcare Professional Verification Form?

Only when the applicant has no other proof of qualification for the Reduced Fare FAREPAY card. A rider with a Medicare card or other accepted documentation does not need it. The form states it is needed only if the applicant lacks other proof, so clinicians should ask before completing it.

Who can complete the UTA verification form?

Any licensed healthcare professional who has examined the applicant. UTA verifies the license through the Utah Division of Occupational and Professional Licensing database, so the license number on the form must be accurate. The professional states that the impairment fits the ADA definition and estimates its duration.