Share A Fare Application

* * For questions about Share A Fare in Kansas City, Missouri please click or call 816-842-9070.

Certifying authority:

Please complete the below online application form for the Share A Fare program for your patient/client/consumer. Alternatively, download .pdf version of application.

If providing a post office box as a primary mailing address, we also require, for geographical purposes, a physical street address of residency.  Without this information, we will be unable to process your application.

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Applicant's Information
Certifying Authority's Information
This section to be completed by Doctor, Nurse, Optometrist, or Rehabilitation Counselor.