Demographic Consent Form(Paratransit Only)
Vouch for Me is a FREE community-based program providing non-emergency medical transportation services to and from medical appointments, grocery stores, and pharmacies to individuals in the Birmingham area. Please complete this application for assistance. A team member will contact you following the review with additional information.
You can submit this application online at maxtransit.org or by using one of the following options:
Mailing Address: 1801 Morris Ave. Birmingham Al. 35203 (Attention: ADA Office)
• Central Station: 1700 Morris Ave. Birmingham, Al. 35203
• Woodlawn Transit: 4802 Ave. W. Birmingham, Al. 35208
• Crossplex Transit Center– 5613 1st Ave. N. Birmingham Al. 35212
For questions or information: Customer Care Center: (205) 521-0101
Limit one round trip
I certify that the information I have provided in this application is true and correct. I understand that falsification of information may result in denial of service. I further understand that all information required herein will be considered confidential and will be used only by The Birmingham-Jefferson County Transit Authority and Daniel Payne Legacy Village Foundation to determine eligibility for transportation services.
Thank you %FULL_NAME% for completing the form.
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We will get back to you if we need additional information.
You can review or edit your submission at any time from the link below:
We have also attached a copy of your submission to this email.
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