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Client Certification Form

  1. OCPT-HORIZ-CMYK

  2. Sex

    Please select an option

  3. Emergency Contact Information

  4. Please Select the service(s) that you are applying for:

    Check all that apply

  5. Medical Equipment

    Select all that apply

  6. Mobility Status

    Please select the option that applies to you

  7. Care Attendant

    Please select the options that applies to you

  8. Passenger Responsibilites

    Make reservations for transportation service a minimum of two business days prior to date of appointment; transit service requests must be made between 9:00 AM - 3:00 PM. Return service to go home must be called into OPT Dispatch at (919) 245-2008; YOU MUST BE READY AND AVAILABLE TO BOARD THE BUS AT 4:30 PM. There is no transit service provided after 4:30 pm.

  9. Instructions for Submission

    This application can be submitted online with the option of receiving a copy by email. You can also print out the application and submit it by mail or fax to our Administration Office. Mailing Address: 600 NC 86 Hillsborough, NC 27278 Fax Number: 919-732-2137

  10. Please type your First and Last Name in the section above.

  11. Processing Consent

    By checking this box you consent to Orange County Public Transportation processing your application.

  12. Leave This Blank:

  13. This field is not part of the form submission.