Person with a Disability Form

The Person with a Disability Form is used to register information by or for those who require additional assistance during a police, fire or medical emergency that would be helpful for emergency personnel to know when responding to a crisis. This information will be entered into Erie County Department of Public Safety’s CAD system for use by Erie County’s 911 dispatchers.

Examples include any physical, mental, sensory or intellectual disability, such as: autism, deaf/hearing impaired, blind/visual impairment, and/or physical disability/mobility impairment.

If the requestor is unable to submit the information, a person who is authorized to act on his/her behalf may do so (guardian, power of attorney, etc.) may submit the form.