New Rider Registration | Access Tusc Website

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New Rider Registration

If you are new to riding with Access Tusc Transit, please fill out the form below prior to scheduling a ride.

Name

Date of Birth

Address

Gender *

Male

Female

Prefer not to specify

Language

English

Spanish

Other

Primary Phone Number

Alternate Phone Number

Mobility Needs *

Ambulatory/Walk Unassisted

Wheelchair

Walker

Special Assistance(s)

Cane

Crutches

Dementia

Hearing Impaired

Visually Impaired

Motorized Scooter

Motorized Wheelchair

Oxygen

Service Animal

Special Instruction for Rider

Walker

Wheelchair

Other

None

Race

African American

Asian

Caucasian (White)

Indian

Other

Escort (Riding with you)

Would you like reminder calls or texts?

Email Address

Notes or Additional Comments

*This is for SELF PAY TRIPS ONLY. If you are eligible for service through an agency, please call the office at 234-801-8007.

Thanks for submitting!

Access Tusc is a not-for-profit, 501(c)3 organization.

This website is for informational purposes only and does not constitute as an endorsement of services.

** For the most up-to-date information on agency services please call providers directly to verify **

Copyright © 2025 Access Tusc. All rights reserved.

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