How to Alert 911 to Your Special Needs

You should complete this form if you want your police department, fire department, ambulance or other emergency response agencies to know about medical conditions or disabilities when you call 911 in an emergency.

Completing this form will alert the 911 dispatcher that you or someone else living in your household has a medical condition or disability.  This information helps the 911 dispatcher to provide the appropriate emergency help. This information will be displayed at the 911 answering point only when you call 911.

The information that you provide will be put into the 911 system and will stay there for a year unless you request that it be changed or removed.   It is your responsibility to notify us when there is a change in the condition described on this form.  When there is a change, please send us an updated form.

In the event of a current emergency,
DO NOT use this form.
Please call 911 immediately.