Special Needs Address Alert Request

If you or someone you care for require special needs or has a medical condition, you may request for an alert to be placed onto their address in our computer-aided dispatch software to inform Dispatchers in the event emergency services called to respond.

Request Type (Required)

Receiving Assistance

Are you completing this form for someone else? (Required)

Personal Information

Name of Individual (Required)
Drag & Drop Files, Choose Files to Upload
Date of Birth (Required)
Residence Address (Required)
Please enter a valid street address within Greenbrier County, WV.
Enter weight in feet-inches
Enter weight in pounds
Special Needs (Required)
Select all that apply.
Please include any additional information that may be helpful to first responders such as: triggers, aversions, medical or dietary issues/requirements, wandering behaviors, atypical characteristics/behaviors, favorite attractions and locations if person is missing, likes and dislikes such as toys or conversation topics. Please include known de-escalation techniques.

Emergency Contact Information

Emergency Contact same as Requesting Party
I consent to have the above address flagged in the Greenbrier County ECC's Computer-Aided Dispatch (CAD) system to notify responders in the event of an emergency call at the above residence. (Required)