Safety Promotion & Education

Emergency Patient Form Available for Download

Emergency responders such as your fire department and local ambulance services often find it difficult to obtain much needed medical information on our patients in an emergency.

Particularly if the patient is unconscious or otherwise incapacitated; accurate, complete information can be hard to find on a patient when it is needed most.

To help alleviate this problem and to make things easier for our pateients, and for the convienence of families and caretakers, we are offereing this free form for you to print out, fill out and have availble in case there is ever an need.

Download or print the file here:

Emergency Form [PDF]

Please note: the use of this form is optional and is provided merely as a convience for the public. No claims are made as to the use of this form and the protection of patient privacy.