Please provide your attending physician’s name, address, phone and fax numbers below so we may send a letter requesting a recommendation for accessible parking at the University of Louisville. This information will be held in strict confidence. Information received will be used solely for the purpose of determining eligibility for accessible parking at the University of Louisville. All long term accessible permit approvals will be reviewed after four years.
MEDICAL AUTHORIZATION RELEASE: Submitting this form authorizes the above listed physician to provide the necessary information to the University of Louisville Parking Office for the purpose of issuing accessible parking privileges on campus.