Emergency Information Form

In an emergency, it’s easy to "forget" even the most well-known information. This Emergency Information Form will help us treat you or your family members if we respond to your home on a medical call. That is why it is crucial for you to complete the information in this form, and update it as needed, for each member of your household.

Once complete, we recommend placing them on your refrigerator so they are easy for you to access when we arrive at your home. Upon our arrival, please provide the paramedics this form to help with the treatment of your family member.

We also encourage you to make copies for non-resident relatives, babysitters, caretakers, neighbors, teachers or anyone who has contact with you or who is periodically responsible for your children (or any disabled or elderly persons in your home).

Our Emergency Information form can be downloaded as a Microsoft Word Document (DOC) or in Portable Document Format (PDF).