MobilityPLUS Application - Health/Disability Professional form

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The applicant is applying for MobilityPLUS. MobilityPLUS is a shared-ride public transit service for persons with disabilities who are unable to use conventional public transit some or all of the time. The information you provide in this form will assist MobilityPLUS to evaluate the applicant’s eligibility. (Note that those people eligible and registered must be at least 12 years old to travel unaccompanied).


This form may also be submitted:

  1. In-person: paper copies can be dropped off at GRT Customer Service Centres at Ainslie Street Terminal, 35 Ainslie Street S., Cambridge, or 105 King St. E., Kitchener or the Transit Operations Centre at 250 Strasburg Road, Kitchener.
  2. By mail: for information about where to mail paper copies, call 519-585-7597 ext. 7345.

This form may also be scanned, uploaded and submitted with the MobilityPLUS Application.

This form is to be completed by a health/ disability professional who is competent to speak to the applicant’s disability(s) and their ability to take conventional transit. Appropriate professionals could include (but are not limited to):

  • Physician
  • Nurse practitioner
  • Psychiatrist
  • Psychologist
  • Optometrist
  • Physiotherapist
  • Occupational Therapist
  • Social Worker
  • Orientation and Mobility Specialist
  • Managers from pre-approved Adult Day Programs or Long-Term Care centres
  • Other professionals approved by the Region

If you have any questions or need assistance, call 519-585-7597 ext. 7345,
Deaf and Hard of Hearing (TTY): 519-575-4608.

Personal Information and Privacy

All personal information collected on this application and any supporting documentation is collected under the authority of the Municipal Act, 2001, and in accordance with the Municipal Freedom of Information and Protection of Privacy Act and is used solely for the purpose of determining eligibility for MobilityPLUS services.

The application and supporting documentation will be reviewed by GRT and its authorized agents/representatives for the purposes of determining MobilityPLUS eligibility and/or service delivery options for MobilityPLUS.

Any questions about this collection should be directed to:

Manager, Marketing, Communications and Customer Service
250 Strasburg Rd.
Kitchener ON N2E 3M6
Deaf and Hard of Hearing (TTY): 519-575-4608