Proof from a Medical Practitioner for a Cambridge City Council Taxicard
Note to medical practitioner: you are asked to endorse that _______________________ has mobility problems that prevent them from using local bus services. It is expected that you will know the applicant and that you will be able to make a comprehensive assessment of their disability. If you feel that you do not know enough about this person, please refer this form to another health professional. In the event that a person’s eligibility is subsequently queried, the matter will be discussed with you further. Beyond this there is no on-going responsibility implied in supporting an application. 
Name: ________________________    Signature:________________________
Date:___________________
Profession:		
Community Nurse		
Occupational Therapist		
Physiotherapist		
Doctor		
Health Visitor		

Place of Work:     __________________________________ 
If no practice stamp is available please enclose a practice compliment slip or letterhead.