Get Mobility Assessment Form - Kiwanis Transit

Completing the Mobility Assessment Form for Kiwanis Transit is essential for individuals seeking specialized transit services. This guide will walk you through each step required to successfully fill out the online form, ensuring clarity and accuracy throughout the process.

Follow the steps to complete the Mobility Assessment Form online.

1. Press the 'Get Form' button to access the Mobility Assessment Form and open it for editing.
2. Begin by completing the diagnosis of illness or disability. Clearly state the medical condition impacting the applicant's mobility.
3. In the next field, describe how the illness or disability affects the applicant’s physical mobility. Provide specific examples to illustrate the challenges faced.
4. Continue by detailing the impact of the illness or disability on the applicant’s cognitive ability. Again, provide clear and illustrative descriptions.
5. Answer the question regarding the applicant's ability to climb or descend three steps by selecting 'YES' or 'NO'.
6. Indicate whether the applicant is physically able to walk 175 meters by choosing 'YES' or 'NO'.
7. Answer the question about the expected improvement in the applicant’s physical mobility by selecting either 'YES' or 'NO'.
8. Specify the time period for which you recommend the applicant use specialized transit by checking the appropriate box for either temporary or permanent usage. If temporary, please provide the anticipated end date.
9. Affirm your assessment of the applicant's mobility restrictions by checking the relevant boxes that apply to their situation.
10. Select your professional designation from the provided options: Physician, Registered Nurse, Occupational Therapist, or Physiotherapist.
11. Finally, print your name, sign the form, and include the date and your contact information as requested.
12. Once all fields are completed, save the changes, and choose to download, print, or share the form as needed.

Compete your Mobility Assessment Form online today and contribute to ensuring that individuals receive the transit services they need.