This form contains valuable information for emergency preparation.
If you need assistance in filling out this form please call the Outreach department At 508-430-7551. In the event of an emergency, it is suggested that you have some form of identification on your person that identifies your name and special needs such as: Diabetes, Memory Impairment, Allergies, Epilepsy, etc. this may be in the form of an I.D. bracelet.
THE ONLY PERSONNEL WITH ACCESS TO THIS FORM ARE POLICE, FIRE, AND THE COUNCIL ON AGING.
Click here for the pdf version of this form.