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Medical Pass  Form

Medical Pass Form

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Does not honour the Medical Pass on their routes. A second pass may be purchased for an attendant accompanying a child or adult that is travelling for physician prescribed treatment(s). MEDICAL AUTHORIZATION FORM PLEASE PRINT: Name: Address: Phone Number: Postal Code: Medical Travel - Thirty (30) Day Period Effective Date: Expiry Date: Origin: Destination: Physician’s Name: Phone Number: IMPORTANT INFORMATION: PLEASE READ CAREFULLY - RESTRICTIONS OF MEDICAL PASS:  Medical...
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